Provider Demographics
NPI:1477957512
Name:ZABLE, ILYSE ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ILYSE
Middle Name:ANNE
Last Name:ZABLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 BRATTLE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2235
Mailing Address - Country:US
Mailing Address - Phone:781-402-9139
Mailing Address - Fax:
Practice Address - Street 1:152 BRATTLE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-2235
Practice Address - Country:US
Practice Address - Phone:781-402-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11264103T00000X
DCPSY1001001103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist