Provider Demographics
NPI:1093274391
Name:KILLIAN SEARLES, MARY LOU (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY LOU
Middle Name:
Last Name:KILLIAN SEARLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY LOU
Other - Middle Name:K
Other - Last Name:BENOIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:607 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3034
Mailing Address - Country:US
Mailing Address - Phone:609-610-2596
Mailing Address - Fax:
Practice Address - Street 1:721 AUTH AVE
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2965
Practice Address - Country:US
Practice Address - Phone:609-610-2596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000265001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical