Provider Demographics
NPI:1760810584
Name:BARILLA, JAIME ANN (LPC)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ANN
Last Name:BARILLA
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 1:155 RIPTIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2538
Mailing Address - Country:US
Mailing Address - Phone:732-766-0785
Mailing Address - Fax:
Practice Address - Street 1:155 RIPTIDE AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2538
Practice Address - Country:US
Practice Address - Phone:732-766-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00483100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional