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General NPI Number Information
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NPI Number | 1013141993
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Entity Type | Organization
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Legal Business Name | NORA ILNICZKY, PH.D., PSYCHOTHERAPY AND WELLBEING, LLC.
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 05/07/2009
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Provider Practice Location Address
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Address Line | 1158 MASSACHUSETTS AVE SUITE #307
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5205
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Country | US
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Telephone | 617-894-0055
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Fax |
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Provider Business Mailing Address
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Address Line | 1158 MASSACHUSETTS AVE SUITE #307
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5205
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Country | US
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Telephone | 617-894-0055
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. NORA KLARA ILNICZKY
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Credential | PH.D.
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Telephone | 617-894-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 8701
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License Number State | MA
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