Provider Demographics
NPI:1558767756
Name:FELLNER, JILL (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:FELLNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 RHEIN CT
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:466 KINDERKAMACK RD
Practice Address - Street 2:SUITE C
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1536
Practice Address - Country:US
Practice Address - Phone:201-749-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-15
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056000001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical