Provider Demographics
NPI:1811927676
Name:KEINER, ILA A (LCSW)
Entity type:Individual
Prefix:
First Name:ILA
Middle Name:A
Last Name:KEINER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S NEW YORK RD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-6025
Mailing Address - Country:US
Mailing Address - Phone:609-748-1820
Mailing Address - Fax:609-404-3116
Practice Address - Street 1:311 S NEW YORK RD
Practice Address - Street 2:SUITE 25
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-6025
Practice Address - Country:US
Practice Address - Phone:609-748-1820
Practice Address - Fax:609-404-3116
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046073001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0019887Medicaid
NJ0019887Medicaid