Basic Information
| Provider Information | |||||||||
| NPI: | 1790716264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARX | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 012065 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 35S100343600 | NJ | N | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.