Individual
DR. BRIAN DAVID ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
935 NORTHERN BLVD STE 102, GREAT NECK, NY 11021-5309
(516) 487-7116
Mailing address
17 RIVERDALE AVE, OAKDALE, NY 11769-1544
(631) 885-2738
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
025970
NY
Other
Enumeration date
12/08/2022
Last updated
09/09/2023
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