Provider Demographics
NPI:1578952933
Name:DUHAMEL, ELLEN (LICSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:DUHAMEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01074-0096
Mailing Address - Country:US
Mailing Address - Phone:978-257-5722
Mailing Address - Fax:
Practice Address - Street 1:15 ELM ST S
Practice Address - Street 2:
Practice Address - City:SOUTH BARRE
Practice Address - State:MA
Practice Address - Zip Code:01074-7711
Practice Address - Country:US
Practice Address - Phone:978-257-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA1268381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health