Provider Demographics
NPI:1982348058
Name:ILLADES, LUIS GABRIEL (CASAC, LMSW)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:GABRIEL
Last Name:ILLADES
Suffix:
Gender:M
Credentials:CASAC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4626
Mailing Address - Country:US
Mailing Address - Phone:415-845-4964
Mailing Address - Fax:
Practice Address - Street 1:190 N 10TH ST STE 203
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-9317
Practice Address - Country:US
Practice Address - Phone:646-779-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1328670011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical