Provider Demographics
NPI:1194916338
Name:FROST, ELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:FROST
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 1:200 EAST 33 ST
Mailing Address - Street 2:SUITE 25J
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4874
Mailing Address - Country:US
Mailing Address - Phone:212-725-0543
Mailing Address - Fax:212-725-0543
Practice Address - Street 1:200 EAST 33 ST
Practice Address - Street 2:SUITE #25J
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10016-4874
Practice Address - Country:US
Practice Address - Phone:212-725-0543
Practice Address - Fax:212-725-0543
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007268103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV64901Medicare UPIN
NYV64901Medicare PIN