Provider Demographics
NPI:1811182637
Name:ADLER, LILLINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LILLINE
Middle Name:
Last Name:ADLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 MAIN ST STE 1F
Mailing Address - Street 2:
Mailing Address - City:ALLENHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07711-1232
Mailing Address - Country:US
Mailing Address - Phone:732-996-2780
Mailing Address - Fax:
Practice Address - Street 1:560 MAIN ST
Practice Address - Street 2:SUITE 1F
Practice Address - City:ALLENHURST
Practice Address - State:NJ
Practice Address - Zip Code:07711-1231
Practice Address - Country:US
Practice Address - Phone:732-996-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2013-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X, 103TS0200X
NJ35SI100499000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool