Healthcare Provider Details

I. General information

NPI: 1750047254
Provider Name (Legal Business Name): EILISH WALSHLENNON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 NETHERLAND AVE APT 2B
BRONX NY
10463-3423
US

IV. Provider business mailing address

3215 NETHERLAND AVE APT 2B
BRONX NY
10463-3423
US

V. Phone/Fax

Practice location:
  • Phone: 646-756-9067
  • Fax:
Mailing address:
  • Phone: 646-756-9067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number880770
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: