Provider Demographics
NPI:1629842695
Name:SACKS, ILYSE HOPE (BA)
Entity Type:Individual
Prefix:
First Name:ILYSE
Middle Name:HOPE
Last Name:SACKS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 PHILMONT AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-5368
Mailing Address - Country:US
Mailing Address - Phone:215-947-4100
Mailing Address - Fax:
Practice Address - Street 1:2755 PHILMONT AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-5368
Practice Address - Country:US
Practice Address - Phone:215-947-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)