Healthcare Provider Details

I. General information

NPI: 1942329222
Provider Name (Legal Business Name): CONNIE CITRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SAYRE AVE
PHILLIPSBURG NJ
08865-3326
US

IV. Provider business mailing address

26 SAFRAN AVE ATTN: S. GILL
EDISON NJ
08837-3510
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-2074
  • Fax: 908-454-9871
Mailing address:
  • Phone: 732-738-1323
  • Fax: 732-738-6017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37FI00158600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: