Healthcare Provider Details

I. General information

NPI: 1811182637
Provider Name (Legal Business Name): LILLINE ADLER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 11/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 MAIN ST SUITE 1F
ALLENHURST NJ
07711-1231
US

IV. Provider business mailing address

560 MAIN ST STE 1F
ALLENHURST NJ
07711-1232
US

V. Phone/Fax

Practice location:
  • Phone: 732-996-2780
  • Fax:
Mailing address:
  • Phone: 732-996-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI100499000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: