Provider Demographics
NPI:1356086318
Name:CIRILLO STRACHAN, DINA (LAC)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:CIRILLO STRACHAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:STRACHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:35 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4617
Mailing Address - Country:US
Mailing Address - Phone:856-272-7100
Mailing Address - Fax:
Practice Address - Street 1:35 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-4617
Practice Address - Country:US
Practice Address - Phone:856-272-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00633000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health