Provider Demographics
NPI:1508630633
Name:MILICIA, EILEEN ELIZABETH
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:ELIZABETH
Last Name:MILICIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 RARITAN AVE STE 306A
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2752
Mailing Address - Country:US
Mailing Address - Phone:732-421-3762
Mailing Address - Fax:
Practice Address - Street 1:320 RARITAN AVE STE 306A
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2752
Practice Address - Country:US
Practice Address - Phone:732-629-8269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00758500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional