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DR. MARY ANNE ELLIS JD,PSYD
NPI 1972813467
Psychologist - Clinical Child & Adolescent in Vienna, VA

Active since October 18, 2010Opted out of Medicare · through Apr 1, 2028
133 PARK ST NE, VIENNA, VA 22180(703) 281-2657(703) 242-0014 Get Directions Write a Review

NPPES record last updated: October 18, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Mary Anne Ellis Jd,psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MARY ANNE ELLIS JD,PSYD (NPI 1972813467) is an individual clinical child & adolescent provider in Vienna, Virginia, licensed in Virginia (0810004323) and active in the NPI registry since October 2010. She has opted out of Medicare through April 1, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1972813467
Entity TypeIndividualFemale
Primary Taxonomy103TC2200X
Provider Legal NameDR. MARY ANNE ELLISCredential: JD,PSYD
Location Address133 PARK ST NEVienna, VA 22180-4602
Mailing Address133 Park St NeVienna, VA 22180-4602 · (703) 281-2657 · Fax (703) 242-0014
Phone(703) 281-2657
Fax(703) 242-0014
Sole ProprietorNo
Enumeration DateOctober 18, 2010
✔ NPI 1972813467 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · Clinical Child & AdolescentBehavioral Health & Social Service Providers
Taxonomy Code103TC2200X
License✔ Licensed in VA · 0810004323
Definition
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.
133 PARK ST NE, Vienna, VA 22180
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Mary Anne Ellis Jd,psyd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 1, 2018 through April 1, 2028.

Opt-Out Effective DateApril 1, 2018
Opt-Out In Effect ThroughApril 1, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SANDRA L MONCRIEF-STUART MA, MSW
Social Worker (Clinical)
133 PARK ST NE
VIENNA, VA 22180
Fairfax County (703) 281-4928
THE COLLABORATIVE GOOD, LLC
Social Worker (Clinical)
133 PARK ST NE, #3B
VIENNA, VA 22180
Fairfax County (718) 974-7037
ROSE MARIE MCINTRYE LCSW
Social Worker (Clinical)
133 PARK ST NE
VIENNA, VA 22180
Fairfax County (703) 281-2657
LAURA WINKLER
Counselor (Professional)
133 PARK ST NE
VIENNA, VA 22180
Fairfax County (703) 281-6657
MARY JAQUELIN SIMONS MSW, LCSW
Social Worker (Clinical)
133 PARK ST NE
VIENNA, VA 22180
Fairfax County (703) 281-4928
MS. ANN BOYER HOLMES LCSW
Social Worker (Clinical)
133 PARK ST NE
VIENNA, VA 22180
Fairfax County (703) 281-4928
MS. BARBARA ELIZABETH ECKERT LCSW
Social Worker (Clinical)
133 PARK ST NE
VIENNA, VA 22180
Fairfax County (703) 281-4928
ILEANE KENNEY L.C.S.W.
Social Worker (Clinical)
133 PARK ST NE
VIENNA, VA 22180
Fairfax County (703) 281-2657

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Ellis's NPI number?

The NPI number for Mary Ellis is 1972813467. It was assigned to this individual provider in the NPPES registry on October 18, 2010.

Where is Mary Ellis located?

Mary Ellis practices at 133 Park St NE, Vienna, VA 22180. The listed phone number is (703) 281-2657.

What is Mary Ellis's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical Child & Adolescent, with taxonomy code 103TC2200X.

Is Mary Ellis enrolled in Medicare?

No. Mary Ellis has opted out of Medicare through April 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Mary Ellis was last updated on October 18, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.