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General NPI Number Information
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NPI Number | 1992969687
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Entity Type | Organization
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Legal Business Name | ILA A. KEINER LLC
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | ROUTE 9 AND CENTRAL AVE CENTRAL SQUARE UNIT 61A
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City | LINWOOD
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State | NJ
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Zip | 08221
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Country | US
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Telephone | 609-748-1820
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Fax | 609-404-3116
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Provider Business Mailing Address
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Address Line | 833 E MOSS MILL RD
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City | GALLOWAY
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State | NJ
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Zip | 08205-4218
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Country | US
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Telephone | 609-748-1820
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Fax | 609-404-3116
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MS. ILA ANN KEINER
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Credential | LCSW
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Telephone | 609-748-1820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC46073
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License Number State | NJ
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