Provider Demographics
NPI:1477583037
Name:SILLUP, MARY MARGARET (EDS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:SILLUP
Suffix:
Gender:F
Credentials:EDS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 RED FOX RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8165
Mailing Address - Country:US
Mailing Address - Phone:732-308-3834
Mailing Address - Fax:732-536-9953
Practice Address - Street 1:81 BRIDGE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1700
Practice Address - Country:US
Practice Address - Phone:732-536-8520
Practice Address - Fax:732-536-9953
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100112000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist