Provider Demographics
NPI:1528637667
Name:KILEY, ILANA L (LCSW)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:L
Last Name:KILEY
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 1:54 FOREST DR APT D
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-2169
Mailing Address - Country:US
Mailing Address - Phone:845-216-3823
Mailing Address - Fax:
Practice Address - Street 1:54 FOREST DR APT D
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-2169
Practice Address - Country:US
Practice Address - Phone:845-216-3823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0768061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical