Provider Demographics
NPI:1215018676
Name:JOSEPH, GREGORY WILLIAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WILLIAM
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 LINCOLN DR W
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3402
Mailing Address - Country:US
Mailing Address - Phone:856-797-0791
Mailing Address - Fax:856-983-3426
Practice Address - Street 1:12000 LINCOLN DR W
Practice Address - Street 2:SUITE 105
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3402
Practice Address - Country:US
Practice Address - Phone:856-797-0791
Practice Address - Fax:856-983-3426
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00307200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical