Irma R. Ilustre, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

112172 Issued in MA

Practice address

170 Main St
Unit G-02
Tewksbury, MA 01876-1765

Phone

(617) 969-7600

Fax

(617) 969-7646

NPI assigned

Jan 9, 2007

Last updated

Mar 18, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Child and Family Psychological Services, PLLC

  dba LifeStance Health

  • Psychologist
  • Norwood, MA
  • NPI 1912987181

  Clinical

  NPD (past)
• Psychological Care Associates, P.C.

  • Clinical Psychologist
  • Woburn, MA
  • NPI 1194770479
  NPD (past)
• South Shore Mental Health Center, Inc.

  dba Aspire Health Alliance

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Quincy, MA
  • NPI 1770528317
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205798400000",
    "number": "1649329921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 ALFRED ST",
            "address_2": "SUITE 200",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011915",
            "telephone_number": "781-646-0500",
            "fax_number": "781-646-7130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 MAIN ST",
            "address_2": "UNIT G-02",
            "city": "TEWKSBURY",
            "state": "MA",
            "postal_code": "018761765",
            "telephone_number": "617-969-7600",
            "fax_number": "617-969-7646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILUSTRE",
        "first_name": "IRMA",
        "middle_name": "R.",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2008-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "112172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya G Holstein, LICSW
• Horizon Home Care
• Sarah Houle, PT
• Barbara B Hoye, LICSW
• Isadora Hurtado
• Brithny Imafidon, FNP-C
• Integrity Home Care Solutions, LLC
• Cheryl Jacobs, LICSW
• Rosemary C. Janas, FNP
• Adam Thomas Jankowski

• Clinical Social Worker in Tewksbury, MA
• Providers in Tewksbury, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.