Individual
DR. ELLEN D NANNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
57 BEDFORD ST, SUITE 125, LEXINGTON, MA 02420-4500
(781) 861-1818
(781) 861-2057
Mailing address
38 LINCOLN ST, LEXINGTON, MA 02421-6824
(781) 861-1818
(781) 861-2057
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6950
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11434
OPTIONS PROVIDER NUMBER
MA
01
—
755578
TUFTS PROVIDER NUMBER
MA
01
—
W05477
BLUE CROSS PROVIDER NUMBE
MA
Enumeration date
08/20/2006
Last updated
07/08/2007
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