Provider Demographics
NPI:1922581677
Name:JOSEPH R. DAVIDOW, ED.D., LLC
Entity Type:Organization
Organization Name:JOSEPH R. DAVIDOW, ED.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIDOW
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:609-601-7737
Mailing Address - Street 1:2021 NEW RD STE 10
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1045
Mailing Address - Country:US
Mailing Address - Phone:609-601-7737
Mailing Address - Fax:609-601-7739
Practice Address - Street 1:2021 NEW RD STE 10
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1045
Practice Address - Country:US
Practice Address - Phone:609-601-7737
Practice Address - Fax:609-601-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)