Provider Demographics
NPI:1144534447
Name:ILDEYKINA, EKATERINA I (MFT)
Entity type:Individual
Prefix:
First Name:EKATERINA
Middle Name:
Last Name:ILDEYKINA
Suffix:I
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PURCHASE ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6355
Mailing Address - Country:US
Mailing Address - Phone:508-990-0894
Mailing Address - Fax:
Practice Address - Street 1:800 PURCHASE ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6355
Practice Address - Country:US
Practice Address - Phone:508-990-0894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist