Provider Demographics
NPI:1194160507
Name:LISA TORTORELLO GILLIGAN MSW LCSW LLC
Entity type:Organization
Organization Name:LISA TORTORELLO GILLIGAN MSW LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TORTORELLO-GILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-609-0169
Mailing Address - Street 1:300 KIMBALL ST STE 106
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-2506
Mailing Address - Country:US
Mailing Address - Phone:732-609-0169
Mailing Address - Fax:732-218-8601
Practice Address - Street 1:300 KIMBALL ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2513
Practice Address - Country:US
Practice Address - Phone:732-609-0169
Practice Address - Fax:732-218-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053649001041C0700X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AETNAOtherAETNA