Provider Demographics
NPI:1073220885
Name:KILIC, NURSEN (LAC)
Entity Type:Individual
Prefix:
First Name:NURSEN
Middle Name:
Last Name:KILIC
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 OTTO AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-2012
Mailing Address - Country:US
Mailing Address - Phone:856-495-2411
Mailing Address - Fax:
Practice Address - Street 1:502 OTTO AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER PARK
Practice Address - State:NJ
Practice Address - Zip Code:08010-2012
Practice Address - Country:US
Practice Address - Phone:856-495-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00674700101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37AC00674700OtherSTATE OF NEW JERSEY ATTORNEY GENERAL