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General NPI Number Information
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NPI Number | 1306229091
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Entity Type | Organization
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Legal Business Name | KATHLEEN LILLEY
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 233 S ALBANY ST
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City | ITHACA
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State | NY
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Zip | 14850-5403
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Country | US
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Telephone | 607-272-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 233 S ALBANY ST
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City | ITHACA
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State | NY
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Zip | 14850-5403
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Country | US
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Telephone | 607-272-8600
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | KATHLEEN LILLEY
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Credential | LCSW-R
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Telephone | 607-272-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | RO32001
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License Number State | NY
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