Basic Information
Provider Information
NPI: 1790716264
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARX
FirstName: ELLEN
MiddleName: J.
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9 LAKESIDE DR
Address2:  
City: NEW WINDSOR
State: NY
PostalCode: 125535934
CountryCode: US
TelephoneNumber: 8454960740
FaxNumber:  
Practice Location
Address1: 230 NORTH RD
Address2:  
City: POUGHKEEPSIE
State: NY
PostalCode: 126011328
CountryCode: US
TelephoneNumber: 8454863570
FaxNumber: 8454863599
Other Information
ProviderEnumerationDate: 07/05/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X35S100343600NJN Behavioral Health & Social Service ProvidersPsychologistClinical
103TC0700X012065NYY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


Home