MEDICARE: DR. GREGORY WILLIAM JOSEPH PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	35SI00307200	NJ

General Provider Information

NPI Number	:	1215018676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY WILLIAM JOSEPH PSY.D.

Provider Business Mailing Address
First Line	:	12000 LINCOLN DR W
Second Line	:	SUITE 105
City	:	MARLTON
State	:	NJ
Zip	:	08053-3402
Country	:	US
Telephone Number	:	856-797-0791
Fax Number	:	856-983-3426

Provider Business Practice Location Address
First Line	:	12000 LINCOLN DR W
Second Line	:	SUITE 105
City	:	MARLTON
State	:	NJ
Zip	:	08053-3402
Country	:	US
Telephone Number	:	856-797-0791
Fax Number	:	856-983-3426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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