Provider Demographics
NPI:1720527716
Name:BERNSTEIN, ILANA
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:BERNSTEIN
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 1:440 W 114TH ST
Mailing Address - Street 2:6 FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1796
Mailing Address - Country:US
Mailing Address - Phone:212-523-5687
Mailing Address - Fax:
Practice Address - Street 1:440 W 114TH ST
Practice Address - Street 2:6 FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1796
Practice Address - Country:US
Practice Address - Phone:212-523-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093088-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical