Healthcare Provider Details

I. General information

NPI: 1437766839
Provider Name (Legal Business Name): CATHERINE ILLENYE LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1172 E RIDGEWOOD AVE STE 7
RIDGEWOOD NJ
07450-3929
US

IV. Provider business mailing address

240 MAIN ST APT 402
HACKENSACK NJ
07601-5745
US

V. Phone/Fax

Practice location:
  • Phone: 862-345-7570
  • Fax:
Mailing address:
  • Phone: 732-535-1426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE ILLENYE
Title or Position: OWNER
Credential: LCSW
Phone: 732-535-1426