Provider Demographics
NPI:1407934953
Name:REICH, ILANA (PHD)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:REICH
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 1:1324 VICTORY BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301
Mailing Address - Country:US
Mailing Address - Phone:718-448-5559
Mailing Address - Fax:718-815-1563
Practice Address - Street 1:1324 VICTORY BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301
Practice Address - Country:US
Practice Address - Phone:718-448-5559
Practice Address - Fax:718-815-1563
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06077103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0008600OtherGHI
NY146696OtherVALUE OPTIONS
NY0008600OtherGHI