Provider Demographics
NPI:1497789382
Name:GORE, JOYCE D (EDS)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:D
Last Name:GORE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CROWN CT
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-4301
Mailing Address - Country:US
Mailing Address - Phone:732-972-1681
Mailing Address - Fax:732-972-6014
Practice Address - Street 1:80 BRIDGE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1700
Practice Address - Country:US
Practice Address - Phone:732-786-1700
Practice Address - Fax:732-972-6014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1311106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist