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General NPI Number Information
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NPI Number | 1548626856
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Entity Type | Organization
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Legal Business Name | GREGORY W. JOSEPH, PSY.D., LLC
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 651 ROUTE 73 N SUITE 105
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City | MARLTON
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State | NJ
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Zip | 08053-3444
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Country | US
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Telephone | 856-797-0791
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Fax | 856-983-3426
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Provider Business Mailing Address
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Address Line | 651 ROUTE 73 N SUITE 105
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City | MARLTON
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State | NJ
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Zip | 08053-3444
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Country | US
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Telephone | 856-797-0791
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Fax | 856-983-3426
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY JOSEPH
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Credential |
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Telephone | 856-797-0791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00307200
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License Number State | NJ
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