Provider Demographics
NPI:1184788903
Name:DEMEYER, JOSEPH A (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:DEMEYER
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 1:1330 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4057
Mailing Address - Country:US
Mailing Address - Phone:973-696-8554
Mailing Address - Fax:908-756-2283
Practice Address - Street 1:1330 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4057
Practice Address - Country:US
Practice Address - Phone:973-696-8554
Practice Address - Fax:908-756-2283
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI001897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3808009Medicaid
NJ3808009Medicaid