Provider Demographics
NPI:1295210755
Name:PURDY, JOANN M (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:M
Last Name:PURDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1208
Mailing Address - Country:US
Mailing Address - Phone:190-862-5349
Mailing Address - Fax:
Practice Address - Street 1:615 SHERWOOD PKWY
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2525
Practice Address - Country:US
Practice Address - Phone:908-625-3492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053991001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical