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General NPI Number Information
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NPI Number | 1811365224
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Entity Type | Individual
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Provider Name | CATHERINE ILLENYE LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 01/01/2026
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Provider Practice Location Address
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Address Line | 1172 E RIDGEWOOD AVE STE 7
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3929
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Country | US
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Telephone | 732-535-1426
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Fax |
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Provider Business Mailing Address
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Address Line | 240 MAIN ST APT 402
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City | HACKENSACK
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State | NJ
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Zip | 07601-5745
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Country | US
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Telephone | 732-535-1426
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05816800
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License Number State | NJ
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