Provider Demographics
NPI:1457684680
Name:DIMARCO, ILYSE DOBROW (PHD)
Entity Type:Individual
Prefix:DR
First Name:ILYSE
Middle Name:DOBROW
Last Name:DIMARCO
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 1:136 E 57TH ST
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2707
Mailing Address - Country:US
Mailing Address - Phone:212-308-9882
Mailing Address - Fax:
Practice Address - Street 1:136 E 57TH ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2707
Practice Address - Country:US
Practice Address - Phone:212-308-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018104103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical