Provider Demographics
NPI:1063505717
Name:ALBANESE, ILANA XENIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ILANA
Middle Name:XENIA
Last Name:ALBANESE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15421 WHISTLING STRAITS DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-3838
Mailing Address - Country:US
Mailing Address - Phone:512-671-8877
Mailing Address - Fax:512-671-9988
Practice Address - Street 1:12741 RESEARCH BOULEVARD
Practice Address - Street 2:SUITE 700
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-413-9514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-5615TX103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164255OtherVALUE OPTIONS BEHAVIORAL
TX0069ELOtherBLUE CROSS BLUE SHIELD