Provider Demographics
NPI:1013141993
Name:NORA ILNICZKY, PH.D., PSYCHOTHERAPY AND WELLBEING, LLC.
Entity Type:Organization
Organization Name:NORA ILNICZKY, PH.D., PSYCHOTHERAPY AND WELLBEING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NORA
Authorized Official - Middle Name:KLARA
Authorized Official - Last Name:ILNICZKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-894-0055
Mailing Address - Street 1:1158 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE #307
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5205
Mailing Address - Country:US
Mailing Address - Phone:617-894-0055
Mailing Address - Fax:
Practice Address - Street 1:1158 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE #307
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5205
Practice Address - Country:US
Practice Address - Phone:617-894-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8701261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health