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General NPI Number Information
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NPI Number | 1528493319
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Entity Type | Individual
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Provider Name | COLBY WUILLERMIN L.A.C., N.C.C
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Gender | Female
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 8 S 3RD AVE
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City | HIGHLAND PARK
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State | NJ
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Zip | 08904-2510
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Country | US
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Telephone | 732-246-8439
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Fax |
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Provider Business Mailing Address
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Address Line | 307 19TH ST S
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City | BRIGANTINE
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State | NJ
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Zip | 08203-2025
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Country | US
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Telephone | 609-457-6489
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health
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License Number | 37AC00170800
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License Number State | NJ
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