Provider Demographics
NPI:1538211495
Name:MILLER POND, ELLEN MARGARET (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MARGARET
Last Name:MILLER POND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SAMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-878-9650
Mailing Address - Fax:203-256-8532
Practice Address - Street 1:148 BEACH ROAD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824
Practice Address - Country:US
Practice Address - Phone:203-255-2631
Practice Address - Fax:203-256-8532
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT0067371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical