Provider Demographics
NPI:1760720320
Name:ILLIANO, GINA (LMHC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:ILLIANO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHAPEL ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1952
Mailing Address - Country:US
Mailing Address - Phone:718-398-0153
Mailing Address - Fax:718-623-2531
Practice Address - Street 1:25 CHAPEL ST
Practice Address - Street 2:SUITE 901
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1952
Practice Address - Country:US
Practice Address - Phone:718-398-0153
Practice Address - Fax:718-623-2531
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY18 006152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)