Provider Demographics
NPI:1629004981
Name:ILLING, CECELIA (LCSW)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:
Last Name:ILLING
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 1:153 OLD TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:PORT MURRAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07865-3216
Mailing Address - Country:US
Mailing Address - Phone:908-334-6242
Mailing Address - Fax:907-979-0035
Practice Address - Street 1:153 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:PORT MURRAY
Practice Address - State:NJ
Practice Address - Zip Code:07865-3216
Practice Address - Country:US
Practice Address - Phone:908-334-6242
Practice Address - Fax:907-979-0035
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051585001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ057770Medicare ID - Type Unspecified