Provider Demographics
NPI:1356948939
Name:PRICE, ILANA MARIA (LCAT, ATR-BC, CLAT)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:MARIA
Last Name:PRICE
Suffix:
Gender:F
Credentials:LCAT, ATR-BC, CLAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 OCEAN AVE APT 4C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3757
Mailing Address - Country:US
Mailing Address - Phone:203-722-4370
Mailing Address - Fax:
Practice Address - Street 1:36 W 25TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2706
Practice Address - Country:US
Practice Address - Phone:657-522-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002491221700000X
CT0071221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty