MEDICARE: JILL FELLNER L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05600000	NJ

General Provider Information

NPI Number	:	1558767756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL FELLNER L.C.S.W.

Provider Business Mailing Address
First Line	:	107 HAWTHORNE AVE APT E
Second Line	:
City	:	PARK RIDGE
State	:	NJ
Zip	:	07656-3205
Country	:	US
Telephone Number	:	917-478-5669
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 KINDERKAMACK RD STE 2
Second Line	:
City	:	ORADELL
State	:	NJ
Zip	:	07649-1500
Country	:	US
Telephone Number	:	201-749-0065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2014
Last Update Date	:	12/17/2025

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