Provider Demographics
NPI:1770681900
Name:DEVERY, WILLIAM C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:DEVERY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CORNELL DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5318
Mailing Address - Country:US
Mailing Address - Phone:732-698-0280
Mailing Address - Fax:
Practice Address - Street 1:1345 N RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2348
Practice Address - Country:US
Practice Address - Phone:718-351-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027896-11041C0700X
NJSC 074601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0019274OtherGHI