Provider Demographics
NPI:1154645182
Name:DEGUIDA, ELLYN (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELLYN
Middle Name:
Last Name:DEGUIDA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 W WISSAHICKON AVE
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1917
Mailing Address - Country:US
Mailing Address - Phone:215-233-9232
Mailing Address - Fax:
Practice Address - Street 1:31 W WISSAHICKON AVE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1917
Practice Address - Country:US
Practice Address - Phone:215-233-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054174001041C0700X
PACW0163541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical