Provider Demographics
NPI:1902444060
Name:ILENE A. BRICKLEY, PLLC
Entity Type:Organization
Organization Name:ILENE A. BRICKLEY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRICKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-821-0206
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-0333
Mailing Address - Country:US
Mailing Address - Phone:631-786-1565
Mailing Address - Fax:
Practice Address - Street 1:565 ROUTE 25A STE LR5
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2666
Practice Address - Country:US
Practice Address - Phone:631-786-1565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty