Doctor Name: | DIANA ILYASOVA |
NPI Number: | 1700297736 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 3572784 |
Business Practice Address: | 79-25 150th St Apt. B11 Flushing, NY - 11367 |
Business Phone Number: | 3475936089 |
Business Fax Number: | |
Mailing Address: | 79-25 150th St, Apt. B11 FLUSHING |
State: | NY |
Postal Code: | 11367 |
Phone Number: | 3475936089 |
Fax Number: | |
NPI Enumeration Date: | 05/13/2014 |
NPI Last Update Date: | 05/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 3572784 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |