Provider Demographics
NPI:1891531844
Name:ILISHAYEV, RAKHAMIM
Entity type:Individual
Prefix:
First Name:RAKHAMIM
Middle Name:
Last Name:ILISHAYEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OCEAN PKWY APT 6N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4081
Mailing Address - Country:US
Mailing Address - Phone:347-653-5426
Mailing Address - Fax:
Practice Address - Street 1:300 OCEAN PKWY APT 6N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4081
Practice Address - Country:US
Practice Address - Phone:347-653-5426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health