Healthcare Provider Details

I. General information

NPI: 1255750634
Provider Name (Legal Business Name): CAROL ANN CILONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 VERNON CT
WOODLAND PARK NJ
07424-2737
US

IV. Provider business mailing address

2 VERNON CT
WOODLAND PARK NJ
07424-2737
US

V. Phone/Fax

Practice location:
  • Phone: 973-684-7656
  • Fax:
Mailing address:
  • Phone: 973-684-7656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00588900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: