Healthcare Provider Details

I. General information

NPI: 1164412904
Provider Name (Legal Business Name): JOSEPH MCBRIDE MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 PRINCETON PIKE SUITE 5
LAWRENCEVILLE NJ
08648-3261
US

IV. Provider business mailing address

2999 PRINCETON PIKE SUITE 5
LAWRENCEVILLE NJ
08648-3261
US

V. Phone/Fax

Practice location:
  • Phone: 609-771-6737
  • Fax: 609-882-9462
Mailing address:
  • Phone: 609-771-6737
  • Fax: 609-882-9462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number77SC00483900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW-006496-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: