Provider Demographics
NPI:1639751753
Name:ELLISON, DENISE W
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:W
Last Name:ELLISON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PAPINEAU ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3417
Mailing Address - Country:US
Mailing Address - Phone:413-262-3721
Mailing Address - Fax:413-507-3363
Practice Address - Street 1:15 PAPINEAU ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3417
Practice Address - Country:US
Practice Address - Phone:413-262-3721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2084103K00000X
CT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician