Provider Demographics
NPI:1942329222
Name:CITRO, CONNIE
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:CITRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SAFRAN AVE
Mailing Address - Street 2:ATTN: S. GILL
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3510
Mailing Address - Country:US
Mailing Address - Phone:732-738-1323
Mailing Address - Fax:732-738-6017
Practice Address - Street 1:700 SAYRE AVE
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-3326
Practice Address - Country:US
Practice Address - Phone:908-454-2074
Practice Address - Fax:908-454-9871
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00158600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist