Provider Demographics
NPI:1649496894
Name:LILL, CHRISTINE B (MSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:B
Last Name:LILL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MAIN STREET
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753
Mailing Address - Country:US
Mailing Address - Phone:732-240-0509
Mailing Address - Fax:732-240-7435
Practice Address - Street 1:802 MAIN STREET
Practice Address - Street 2:SUITE 1A
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-240-0509
Practice Address - Fax:732-240-7435
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046348001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ74-3147123OtherEIN