Provider Demographics
NPI:1487893731
Name:IVY TILSON INC
Entity type:Organization
Organization Name:IVY TILSON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:W
Authorized Official - Last Name:TILSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:914-777-1023
Mailing Address - Street 1:655 N BARRY AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1608
Mailing Address - Country:US
Mailing Address - Phone:914-777-1023
Mailing Address - Fax:914-777-1024
Practice Address - Street 1:655 N BARRY AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1608
Practice Address - Country:US
Practice Address - Phone:914-777-1023
Practice Address - Fax:914-777-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0098021252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency