Individual
CAROLEE E ILTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
510 HAIGHT AVENUE, STE 203 SPECTRURM BEHAVIORAL MANAGEMENT SERV INC, POUGHKEEPSIE, NY 12603-2408
(845) 485-9098
(845) 485-8780
Mailing address
20 DANIS AVENUE, POUGHKEEPSIE, NY 12603-2408
(845) 485-3500
(845) 485-8780
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
015446
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033150
BEACON HEALTH STRAT
—
01
—
713312
MVP HEALTH CARE
—
01
—
7488652
AETNA
—
Enumeration date
08/30/2006
Last updated
07/08/2007
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