Provider Demographics
NPI:1710315254
Name:BARAKAT, ILANA
Entity Type:Individual
Prefix:MISS
First Name:ILANA
Middle Name:
Last Name:BARAKAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SAINT FRANCIS PL APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4110
Mailing Address - Country:US
Mailing Address - Phone:607-592-0353
Mailing Address - Fax:
Practice Address - Street 1:3 SAINT FRANCIS PL APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4110
Practice Address - Country:US
Practice Address - Phone:607-592-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68 020264103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical