Provider Demographics
NPI:1760685457
Name:FALLSTICK, MARGARET L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:L
Last Name:FALLSTICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312-1414
Mailing Address - Country:US
Mailing Address - Phone:856-307-9107
Mailing Address - Fax:
Practice Address - Street 1:500 S PENNSVILLE AUBURN RD
Practice Address - Street 2:
Practice Address - City:PENNS GROVE
Practice Address - State:NJ
Practice Address - Zip Code:08069-2936
Practice Address - Country:US
Practice Address - Phone:856-299-3200
Practice Address - Fax:856-299-7183
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00186000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0040801Medicaid
NJ527917Medicare ID - Type Unspecified
NJH11502Medicare UPIN