Provider Demographics
NPI:1770784258
Name:KRILL, BRADFORD DOUGLAS (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:DOUGLAS
Last Name:KRILL
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1001
Mailing Address - Country:US
Mailing Address - Phone:908-256-3263
Mailing Address - Fax:201-355-8270
Practice Address - Street 1:20 WILSEY SQ
Practice Address - Street 2:SUITE C.
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3793
Practice Address - Country:US
Practice Address - Phone:201-445-1068
Practice Address - Fax:201-445-7995
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053086001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical