Provider Demographics
NPI:1407643521
Name:ELLIOTT, KHALIL (MBA, MSW, LSW)
Entity type:Individual
Prefix:MR
First Name:KHALIL
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:
Credentials:MBA, MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 LOWER LANDING RD UNIT 183
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-4125
Mailing Address - Country:US
Mailing Address - Phone:267-581-5696
Mailing Address - Fax:
Practice Address - Street 1:590 LOWER LANDING RD UNIT 183
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-4125
Practice Address - Country:US
Practice Address - Phone:267-581-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140668104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker