Provider Demographics
NPI:1437528239
Name:ILIEVA, IRENA (PHD)
Entity Type:Individual
Prefix:
First Name:IRENA
Middle Name:
Last Name:ILIEVA
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 1:425 E 61ST ST
Mailing Address - Street 2:PH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8722
Mailing Address - Country:US
Mailing Address - Phone:617-515-7645
Mailing Address - Fax:
Practice Address - Street 1:425 E 61ST ST
Practice Address - Street 2:PH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8722
Practice Address - Country:US
Practice Address - Phone:617-515-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral