| Ilene A. Brickley, Pllc | |
|
565 Route 25a Ste Lr5 Miller Place NY 11764-2666 | |
| (631) 786-1565 | |
| Not Available |
| Full Name | Ilene A. Brickley, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 565 Route 25a Ste Lr5, Miller Place, New York |
| Authorized Official Name and Position | Ilene A. Brickley (OWNER) |
| Authorized Official Contact | 6318210206 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ilene A. Brickley, Pllc Po Box 333 Shoreham NY 11786-0333 Ph: (631) 786-1565 | Ilene A. Brickley, Pllc 565 Route 25a Ste Lr5 Miller Place NY 11764-2666 Ph: (631) 786-1565 |
| NPI Number | 1902444060 |
|---|---|
| Provider Enumeration Date | 12/19/2019 |
| Last Update Date | 02/22/2021 |
| Certification Date | 02/22/2021 |
| Medicare PECOS PAC ID | 9234546474 |
|---|---|
| Medicare Enrollment ID | O20210406000198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902444060 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Ilene Brickley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023255866 PECOS PAC ID: 6507273745 Enrollment ID: I20210406000227 |
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