Provider Demographics
NPI:1528716271
Name:USATIN, ELLEN (LPC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:USATIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15-18 ALDEN TER
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3519
Mailing Address - Country:US
Mailing Address - Phone:201-365-7447
Mailing Address - Fax:
Practice Address - Street 1:681 LAWLINS RD UNIT 195
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1486
Practice Address - Country:US
Practice Address - Phone:201-365-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012264101YM0800X
NJ37PC00902100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty