| Illume Psychotherapy Llc | |
|
440 Franklin St Ste 200 Bloomfield NJ 07003-4379 | |
| (973) 206-0282 | |
| Not Available |
| Full Name | Illume Psychotherapy Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 440 Franklin St Ste 200, Bloomfield, New Jersey |
| Authorized Official Name and Position | Stacia Thiel (FOUNDER/THERAPIST) |
| Authorized Official Contact | 9732060282 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illume Psychotherapy Llc 41 Watchung Plz # 176 Montclair NJ 07042-4117 Ph: (973) 206-0282 | Illume Psychotherapy Llc 440 Franklin St Ste 200 Bloomfield NJ 07003-4379 Ph: (973) 206-0282 |
| NPI Number | 1285219576 |
|---|---|
| Provider Enumeration Date | 03/17/2021 |
| Last Update Date | 03/17/2021 |
| Certification Date | 03/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285219576 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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