Provider Demographics
NPI:1124165709
Name:GREENSPAN, ELLEN DIANE (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:DIANE
Last Name:GREENSPAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2005
Mailing Address - Country:US
Mailing Address - Phone:516-623-2465
Mailing Address - Fax:516-623-6891
Practice Address - Street 1:15 CHELSEA DR
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2005
Practice Address - Country:US
Practice Address - Phone:516-623-2465
Practice Address - Fax:516-623-6891
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006975103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist