Provider Demographics
NPI:1821805508
Name:PHILBIN, ELIZA ANNE
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:ANNE
Last Name:PHILBIN
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 1:215 W 108TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2979
Mailing Address - Country:US
Mailing Address - Phone:386-283-1358
Mailing Address - Fax:
Practice Address - Street 1:96 5TH AVE APT 1L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7604
Practice Address - Country:US
Practice Address - Phone:347-601-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P132618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health