Provider Demographics
NPI:1104886308
Name:PAINTER, ELLEN HARRIET (LSWA)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:HARRIET
Last Name:PAINTER
Suffix:
Gender:F
Credentials:LSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 SWEET HOURS WAY
Mailing Address - Street 2:D
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2482
Mailing Address - Country:US
Mailing Address - Phone:301-854-9025
Mailing Address - Fax:301-854-9025
Practice Address - Street 1:1301 PICCARD DR
Practice Address - Street 2:2ND FLOOR/ EMERGENCY SERVICES
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4320
Practice Address - Country:US
Practice Address - Phone:240-777-4143
Practice Address - Fax:240-777-4189
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02090104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker