Provider Demographics
NPI:1336310010
Name:WILLIS, MEGAN POWNALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:POWNALL
Last Name:WILLIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-2336
Mailing Address - Country:US
Mailing Address - Phone:908-757-0102
Mailing Address - Fax:908-757-2923
Practice Address - Street 1:909 MADISON AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-2336
Practice Address - Country:US
Practice Address - Phone:908-757-0102
Practice Address - Fax:908-757-2923
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00450800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist