Healthcare Provider Details

I. General information

NPI: 1225656010
Provider Name (Legal Business Name): JULIE ELIZABETH PSILLOS BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 ROUTE 70 STE 2001
LAKEWOOD NJ
08701-7023
US

IV. Provider business mailing address

329 MARC DR
TOMS RIVER NJ
08753
US

V. Phone/Fax

Practice location:
  • Phone: 732-942-5056
  • Fax:
Mailing address:
  • Phone: 732-278-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: