Healthcare Provider Details

I. General information

NPI: 1316420516
Provider Name (Legal Business Name): ILARIA DIBERNARDO-PHILLIPS CT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4664 LARWELL DR
COLUMBUS OH
43220-3621
US

IV. Provider business mailing address

1346 TENAGRA WAY
COLUMBUS OH
43228-9192
US

V. Phone/Fax

Practice location:
  • Phone: 614-487-7805
  • Fax:
Mailing address:
  • Phone: 330-671-3258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2608000
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: