Provider Demographics
NPI:1487756706
Name:ADLER, ILANA (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:ILANA
Middle Name:
Last Name:ADLER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 WOODCHESTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON (CHESTNUT HILL)
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1051
Mailing Address - Country:US
Mailing Address - Phone:617-527-4265
Mailing Address - Fax:617-527-4265
Practice Address - Street 1:147 WOODCHESTER DRIVE
Practice Address - Street 2:
Practice Address - City:NEWTON (CHESTNUT HILL)
Practice Address - State:MA
Practice Address - Zip Code:02467-1051
Practice Address - Country:US
Practice Address - Phone:617-527-4265
Practice Address - Fax:617-527-4265
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01629Medicare ID - Type Unspecified