Provider Demographics
NPI:1144330598
Name:BILAZARIAN, ROBIN W (LCSW)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:W
Last Name:BILAZARIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 ROUTE 73
Mailing Address - Street 2:SUITE 18
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2352
Mailing Address - Country:US
Mailing Address - Phone:856-231-0833
Mailing Address - Fax:856-231-9091
Practice Address - Street 1:1155 ROUTE 73
Practice Address - Street 2:SUITE 18
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2352
Practice Address - Country:US
Practice Address - Phone:856-231-0833
Practice Address - Fax:856-231-9091
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013937001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5985777OtherAETNA