Individual
ILILLI MAMME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
407 GLENN AVE, EGG HARBOR TOWNSHIP, NJ 08234-6109
(703) 564-1634
Mailing address
407 GLENN AVE, EGG HARBOR TOWNSHIP, NJ 08234-6109
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-418084
NJ
Other
Enumeration date
04/09/2025
Last updated
04/09/2025
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