Provider Demographics
NPI:1396086963
Name:LILL, RICHARD C II (LCSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:LILL
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:802 MAIN ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6576
Mailing Address - Country:US
Mailing Address - Phone:732-240-0509
Mailing Address - Fax:732-240-7435
Practice Address - Street 1:802 MAIN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6576
Practice Address - Country:US
Practice Address - Phone:732-240-0509
Practice Address - Fax:732-240-7435
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ44SL05686000104100000X
NJ44SC055865001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker