DR. MARY ANNE ELLIS JD,PSYD
NPI 1972813467
Psychologist - Clinical Child & Adolescent in Vienna, VA
NPI Status: Active since October 18, 2010
Contact Information
133 PARK ST NE
VIENNA, VA
ZIP 22180
Phone: (703) 281-2657
Fax: (703) 242-0014
- Individual
- Female
- Psychologist
- Clinical Child & Adolescent
- PECOS Enrolled
- Opted-Out Medicare
About MARY ELLIS
This page provides the complete NPI Profile along with additional information for Mary Ellis, a provider established in Vienna, Virginia with a medical specialization in Psychologist, focusing in clinical child & adolescent . The healthcare provider is registered in the NPI registry with number 1972813467 assigned on October 2010. The practitioner's primary taxonomy code is 103TC2200X with license number 0810004323 (VA). The provider is registered as an individual and her NPI record was last updated 15 years ago.
- NPI
- 1972813467
- Provider Name
- DR. MARY ANNE ELLIS JD,PSYD
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 133 PARK ST NE VIENNA, VA 22180
- Location Phone
- (703) 281-2657
- Location Fax
- (703) 242-0014
- Mailing Address
- 133 PARK ST NE VIENNA, VA 22180
- Mailing Phone
- (703) 281-2657
- Mailing Fax
- (703) 242-0014
- Is Sole Proprietor?
- No
- Enumeration Date
- 10-18-2010
- Last Update Date
- 10-18-2010
- Code Navigator
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Mary Ellis opted out of Medicare effective on 04-01-2018 until 04-01-2026. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare but is permitted to order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Psychologist Clinical Child & Adolescent
- Taxonomy Code
- 103TC2200X
- Type
- Behavioral Health & Social Service Providers
- License No.
- 0810004323
- License State
- VA
- Taxonomy Description
- A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents.
Medicare Participation & PECOS Enrollment Status
Mary Ellis is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging and Durable Medical Equipment (DME).
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 04-01-2018
Opt-Out End Date: 04-01-2026
Eligible to Order and Refer? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): No
Eligible to Order or Refer Power Mobility Devices: No
Reviews for DR. MARY ANNE ELLIS JD,PSYD
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 9 | 7 | 2 | 8 | 1 | 3 | 4 | 6 | 7 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 9 | 14 | 2 | 16 | 1 | 6 | 4 | 12 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 9 + 1 + 4 + 2 + 1 + 6 + 1 + 6 + 4 + 1 + 2 + 24 = 63 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 63 = 7 | 7 | ||||||||
The NPI number 1972813467 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1598813354 | MS. KATHARINE ZENER ROSSIER MSW Individual | Social Worker (Clinical) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1659491785 | DR. JANET HUTCHISON KIMBERLING PH.D. Individual | Psychologist (Clinical) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1588787303 | MS. NANCY E. SWAIN MSW, LCSW, CGP Individual | Social Worker (Clinical) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1508086448 | NANCY M MOTTER L.P.C. Individual | Counselor (Professional) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-2657 |
| 1043426877 | ROSE MARIE MCINTRYE LCSW Individual | Social Worker (Clinical) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-2657 |
| 1184831737 | ILEANE KENNEY L.C.S.W. Individual | Social Worker (Clinical) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-2657 |
| 1669681516 | KIRSTIN ANN PICKLE LCSW Individual | Social Worker (Clinical) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-2657 |
| 1912192741 | MR. FREDERICK CONRAD SITZLER LPC Individual | Counselor (Mental Health) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1699950113 | MRS. ANDREA W. LEVY MSW, LCSW Individual | Social Worker (Clinical) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1063685287 | ALISON CORBETT SMITH PH.D. Individual | Psychologist | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1336305572 | MS. KRISTIN MASTER SLACIN LPC Individual | Counselor (Professional) | 133 PARK ST NE THE WOMEN'S CENTER VIENNA, VA 22180 (703) 281-4928 |
| 1235385774 | MS. MIRIAM N TURNER M.E.D., LPC Individual | Counselor (Professional) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1093949505 | MARY JAQUELIN SIMONS MSW, LCSW Individual | Social Worker (Clinical) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1902034994 | JANE K. DELPOPOLO LPC Individual | Counselor (Professional) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1992031744 | JENNIFER ANN MOSSGROVE PH.D. Individual | Psychologist (Clinical) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-2657 |
| 1598091225 | CHRISTINA M. MACISAAC MSW, LCSW Individual | Social Worker (Clinical) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1619204419 | MS. PAULA M DONOVAN MA., MSW, LCSW Individual | Social Worker (Clinical) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1750619961 | MS. KAY WILBER MA Individual | Counselor (Professional) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1033418231 | SANDRA L MONCRIEF-STUART MA, MSW Individual | Social Worker (Clinical) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
| 1437443009 | MRS. KATIE FITE CLARK MA, NCC, LPC Individual | Counselor (Mental Health) | 133 PARK ST NE VIENNA, VA 22180 (703) 281-4928 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1972813467, enumerated in the NPI registry as an "individual" on October 18, 2010
The provider is located at 133 Park St Ne Vienna, Va 22180 and the phone number is (703) 281-2657
The provider's speciality is Psychologist with taxonomy code 103TC2200X with a focus in Clinical Child & Adolescent
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging and Durable Medical Equipment (DME).
No, the provider signed an affidavit on April 01, 2018 to opt-out of the Medicare program. The provider is excluded from the Medicare program until April 01, 2026.
This NPI record was last updated on October 18, 2010. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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