Provider Demographics
NPI:1760630735
Name:SEMON, WILLIAM BLAKE
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BLAKE
Last Name:SEMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SPARROW CT
Mailing Address - Street 2:
Mailing Address - City:THREE BRIDGES
Mailing Address - State:NJ
Mailing Address - Zip Code:08887-2117
Mailing Address - Country:US
Mailing Address - Phone:908-399-1274
Mailing Address - Fax:
Practice Address - Street 1:312 SPARROW CT
Practice Address - Street 2:
Practice Address - City:THREE BRIDGES
Practice Address - State:NJ
Practice Address - Zip Code:08887-2117
Practice Address - Country:US
Practice Address - Phone:908-399-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00500800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional