Provider Demographics
NPI:1164253241
Name:TILLIM, MIRIAM (LCSW)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:TILLIM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:PROSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2101 LAKE RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2354
Practice Address - Country:US
Practice Address - Phone:347-533-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062664001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical