Healthcare Provider Details

I. General information

NPI: 1366216608
Provider Name (Legal Business Name): TAYLOR GREGORY CLOUGH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LINCOLN BLVD
MIDDLESEX NJ
08846-1060
US

IV. Provider business mailing address

150 LINCOLN BLVD APT 2203
MIDDLESEX NJ
08846-1064
US

V. Phone/Fax

Practice location:
  • Phone: 908-635-1863
  • Fax:
Mailing address:
  • Phone: 908-635-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06892600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: