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Individual

LIPA TELLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
11 CEDAR CT, LAKEWOOD, NJ 08701-5002
(929) 545-2807
Mailing address
11 CEDAR CT, LAKEWOOD, NJ 08701-5002
(929) 545-2807

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL07138400
NJ

Other

Enumeration date
10/28/2024
Last updated
10/28/2024
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