Individual
DR. THEODORE JACOB ELLENHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
17 KELLOGG AVE, STE 3, AMHERST, MA 01002-2150
(413) 256-3075
Mailing address
79 SOUTH PLEASANT STREET, ROOM 302, AMHERST, MA 01002
(413) 256-3075
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5069
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W04790
BCBS
MA
Enumeration date
02/20/2007
Last updated
02/25/2020
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