Provider Demographics
NPI:1609430552
Name:TILLES, ANNA FELISE (LMSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:FELISE
Last Name:TILLES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:F
Other - Last Name:TILLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1635 10TH AVE APT 4R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6001
Mailing Address - Country:US
Mailing Address - Phone:917-498-3012
Mailing Address - Fax:
Practice Address - Street 1:1635 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6001
Practice Address - Country:US
Practice Address - Phone:917-498-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105715-1101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor