Individual
PRISCILLA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1121 WASHINGTON ST, SUITE 4, NEWTON, MA 02465-2149
(617) 969-2500
Mailing address
16 OLMSTEAD ST, JAMAICA PLAIN, MA 02130-2910
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2133
MA
Other
Enumeration date
01/17/2007
Last updated
07/08/2007
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