=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477293314
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASSENKA OKSILOFF LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2022
-----------------------------------------------------
Last Update Date | 03/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 NEPTUNE BLVD
-----------------------------------------------------
City | NEPTUNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07753-4838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-767-2200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 262
-----------------------------------------------------
City | ROOSEVELT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08555-0262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-529-1568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 37AC00629600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------