Provider Demographics
NPI:1619224912
Name:IVORY, WILLIAM FRANCIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FRANCIS
Last Name:IVORY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 EAGLE TER
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5006
Mailing Address - Country:US
Mailing Address - Phone:732-251-4800
Mailing Address - Fax:
Practice Address - Street 1:159 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2702
Practice Address - Country:US
Practice Address - Phone:866-895-7592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00494900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist