Provider Demographics
NPI:1043685134
Name:STEIN, ILISA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ILISA
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ILISA
Other - Middle Name:ANNE
Other - Last Name:NAUKAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:95 ALLEN'S CREEK RD
Mailing Address - Street 2:BLDG 1, STE 253
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-364-2553
Mailing Address - Fax:
Practice Address - Street 1:95 ALLEN'S CREEK RD
Practice Address - Street 2:BLDG 1, STE 253
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-364-2553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021427103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist