Provider Demographics
NPI:1598395428
Name:SANTILLI, LYNN J
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:J
Last Name:SANTILLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:SANTILLI CONNOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25 LEGION LN
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1472
Mailing Address - Country:US
Mailing Address - Phone:609-471-2009
Mailing Address - Fax:
Practice Address - Street 1:139 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2821
Practice Address - Country:US
Practice Address - Phone:610-664-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053573001041C0700X
PACW0210101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical