Healthcare Provider Details

I. General information

NPI: 1043048135
Provider Name (Legal Business Name): TA' LISA MARIE HUTTON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CHANLON RD
NEW PROVIDENCE NJ
07974-1543
US

IV. Provider business mailing address

60 W 8TH ST
BURLINGTON NJ
08016-3237
US

V. Phone/Fax

Practice location:
  • Phone: 973-299-9954
  • Fax:
Mailing address:
  • Phone: 609-251-7033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number443L06482000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06482000
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: