MEDICARE: JORGE OLMEDO MURILLO

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	101YM0800X	Mental Health Counselor	101YM0800X

General Provider Information

NPI Number	:	1588454623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE OLMEDO MURILLO

Provider Business Mailing Address
First Line	:	PO BOX 2036
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-8036
Country	:	US
Telephone Number	:	732-703-2689
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 WILLOWBROOK BLVD FL 4
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7025
Country	:	US
Telephone Number	:	973-826-1747
Fax Number	:

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

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	05/12/2025

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Directions to “ JORGE OLMEDO MURILLO ” Practice Location

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