Individual
MR. TODD W ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW
Contact information
Practice address
430 ACADEMY AVE, PROVIDENCE, RI 02908-4100
(401) 865-6019
(401) 865-6019
Mailing address
430 ACADEMY AVE, PROVIDENCE, RI 02908-4100
(401) 865-6019
(401) 865-6019
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
02033
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TE84128
—
RI
Enumeration date
02/16/2011
Last updated
09/07/2015
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