| NPI | 1790292787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE ILLMENSEE Owner/Director 732-610-8396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC05738600) |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2022-10-04 |