Healthcare Provider Details

I. General information

NPI: 1053740076
Provider Name (Legal Business Name): AYRIN L HNOSKO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 E ROUTE 70 BUILDING A-100
MARLTON NJ
08053-2341
US

IV. Provider business mailing address

875 KINGS HWY SUITE 100
WEST DEPTFORD NJ
08096-3165
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-3900
  • Fax: 856-810-0110
Mailing address:
  • Phone: 856-251-0500
  • Fax: 856-251-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05538700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: