Provider Demographics
NPI:1437766839
Name:CATHERINE ILLENYE LCSW
Entity Type:Organization
Organization Name:CATHERINE ILLENYE LCSW
Other - Org Name:CATHERINE ILLENYE, LCSW LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ILLENYE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-535-1426
Mailing Address - Street 1:2237 EDWARD STEC BLVD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-7007
Mailing Address - Country:US
Mailing Address - Phone:732-535-1426
Mailing Address - Fax:
Practice Address - Street 1:1172 E RIDGEWOOD AVE STE 7
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3929
Practice Address - Country:US
Practice Address - Phone:862-345-7570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty