Most Relevant Information
Provider Data
| NPI Number: | 1003484817 |
| Provider Name: | ILEANA LAGRUTTA |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 014572 |
Most Important Dates
| Enumeration Date: | 06/16/2021 |
| Last Updated: | 10/16/2024 |
Provider Practice Location
77 S MAIN ST
NEW CITY
NY
109563511
Practice Location Phone/Fax
| Phone: | 8456345729 |
| Fax: |
Provider Mailing Location
77 S MAIN ST
NEW CITY
NY
109563511
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |