Provider Demographics
NPI:1154620631
Name:CHRISTINE B. LILL LCSW, LLC
Entity type:Organization
Organization Name:CHRISTINE B. LILL LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-240-0509
Mailing Address - Street 1:929 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PINE BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08741-1340
Mailing Address - Country:US
Mailing Address - Phone:732-286-9360
Mailing Address - Fax:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04634800251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649496894OtherINDIVIDUAL NPI