| Ellie Of Maryland Llc | |
|
900 Bestgate Rd Ste 210 Annapolis MD 21401-7922 | |
| (443) 336-9745 | |
| Not Available |
| Full Name | Ellie Of Maryland Llc |
|---|---|
| Speciality | Counselor |
| Location | 900 Bestgate Rd Ste 210, Annapolis, Maryland |
| Authorized Official Name and Position | Michael Richard Stamper (MANAGING PARTNER) |
| Authorized Official Contact | 4433369745 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Of Maryland Llc 227 Pegasus Ct Gambrills MD 21054-1145 Ph: (443) 336-9745 | Ellie Of Maryland Llc 900 Bestgate Rd Ste 210 Annapolis MD 21401-7922 Ph: (443) 336-9745 |
| NPI Number | 1609505213 |
|---|---|
| Provider Enumeration Date | 06/08/2022 |
| Last Update Date | 02/06/2023 |
| Certification Date | 02/06/2023 |
| Medicare PECOS PAC ID | 4082079678 |
|---|---|
| Medicare Enrollment ID | O20230504000915 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609505213 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Naomi J. Weller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740301811 PECOS PAC ID: 7517125586 Enrollment ID: I20120222000169 |
| Provider Name | Mary F Krawczewicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063955227 PECOS PAC ID: 0648519843 Enrollment ID: I20190306001333 |
| Provider Name | Chelsea Tarleton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497280952 PECOS PAC ID: 1658725304 Enrollment ID: I20230928002063 |
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