Provider Demographics
NPI:1649836917
Name:ILSLEY, JANINE LEIGH (LCSW)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:LEIGH
Last Name:ILSLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 JAMES ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2933
Mailing Address - Country:US
Mailing Address - Phone:908-397-2003
Mailing Address - Fax:
Practice Address - Street 1:325 CLAREMONT AVE STE 5
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2218
Practice Address - Country:US
Practice Address - Phone:973-506-8184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105694104100000X
NY0945371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker