Provider Demographics
NPI:1528116548
Name:ALTMAN, ELLEN RENEE (LISW)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:RENEE
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6350
Mailing Address - Country:US
Mailing Address - Phone:352-451-1521
Mailing Address - Fax:352-431-3173
Practice Address - Street 1:104 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6350
Practice Address - Country:US
Practice Address - Phone:352-451-1521
Practice Address - Fax:352-431-3173
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-062071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical