Provider Demographics
NPI:1336696251
Name:TILSON, CHANA (MSED LBA)
Entity Type:Individual
Prefix:
First Name:CHANA
Middle Name:
Last Name:TILSON
Suffix:
Gender:F
Credentials:MSED LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W PALISADE AVE
Mailing Address - Street 2:APT 2210
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2717
Mailing Address - Country:US
Mailing Address - Phone:212-420-1999
Mailing Address - Fax:
Practice Address - Street 1:465 GRAND ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4800
Practice Address - Country:US
Practice Address - Phone:212-420-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY71000813103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst