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General NPI Number Information
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NPI Number | 1477583037
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Entity Type | Individual
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Provider Name | MARY MARGARET SILLUP ED.S., LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 81 BRIDGE PLAZA DR
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City | MANALAPAN
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State | NJ
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Zip | 07726-1700
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Country | US
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Telephone | 732-536-8520
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Fax | 732-536-9953
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Provider Business Mailing Address
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Address Line | 40 RED FOX RD
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City | FREEHOLD
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State | NJ
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Zip | 07728-8165
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Country | US
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Telephone | 732-308-3834
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Fax | 732-536-9953
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37F100112000
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License Number State | NJ
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