MEDICARE: NERLANDE THERLONGE

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
2	1041C0700X	Clinical Social Worker	44SC06389200	NJ

General Provider Information

NPI Number	:	1992303051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NERLANDE THERLONGE

Provider Business Mailing Address
First Line	:	561 MORRIS ST
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-1116
Country	:	US
Telephone Number	:	862-246-6296
Fax Number	:

Provider Business Practice Location Address
First Line	:	561 MORRIS ST
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-1116
Country	:	US
Telephone Number	:	862-246-6296
Fax Number	:

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

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	09/14/2024

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Directions to “ NERLANDE THERLONGE ” Practice Location

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