Provider Demographics
NPI:1881210045
Name:KHALIL, AMELIA (LCADC)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:
Last Name:KHALIL
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1416
Mailing Address - Country:US
Mailing Address - Phone:201-741-8308
Mailing Address - Fax:
Practice Address - Street 1:961 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4510
Practice Address - Country:US
Practice Address - Phone:201-749-2987
Practice Address - Fax:201-833-4455
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00271700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)