Provider Demographics
NPI:1770031114
Name:PHILMORE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PHILMORE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:IPPOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-667-6074
Mailing Address - Street 1:ONE FRANKLIN AVENUE
Mailing Address - Street 2:PO BOX 599
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-0599
Mailing Address - Country:US
Mailing Address - Phone:973-667-6074
Mailing Address - Fax:973-751-1626
Practice Address - Street 1:1 FRANKLIN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3202
Practice Address - Country:US
Practice Address - Phone:973-667-6074
Practice Address - Fax:973-751-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000420001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty