Provider Demographics
NPI:1205682622
Name:ANCHORED ADOLESCENT & CHILD PSYCHIATRY LLC
Entity type:Organization
Organization Name:ANCHORED ADOLESCENT & CHILD PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIERSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ILAOA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:609-525-4947
Mailing Address - Street 1:510 S. SHORE RD (ROUTE 9)
Mailing Address - Street 2:UNIT B
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223
Mailing Address - Country:US
Mailing Address - Phone:609-525-4947
Mailing Address - Fax:
Practice Address - Street 1:510 S. SHORE RD (ROUTE 9)
Practice Address - Street 2:UNIT B
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223
Practice Address - Country:US
Practice Address - Phone:610-416-9802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty