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General NPI Number Information
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NPI Number | 1770681900
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Entity Type | Individual
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Provider Name | WILLIAM C. DEVERY L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 1345 N RAILROAD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2348
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Country | US
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Telephone | 718-351-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 22 CORNELL DR
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5318
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Country | US
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Telephone | 732-698-0280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R027896-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC 07460
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License Number State | NJ
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