Healthcare Provider Details

I. General information

NPI: 1558767756
Provider Name (Legal Business Name): JILL FELLNER L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2014
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 KINDERKAMACK RD STE 2
ORADELL NJ
07649-1500
US

IV. Provider business mailing address

107 HAWTHORNE AVE APT E
PARK RIDGE NJ
07656-3205
US

V. Phone/Fax

Practice location:
  • Phone: 201-749-0065
  • Fax:
Mailing address:
  • Phone: 917-478-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05600000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: