Provider Demographics
NPI:1144332784
Name:JOSEPH, PHILLIP (LCSW)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:JOSEPH
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 1:93 W PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2611
Mailing Address - Country:US
Mailing Address - Phone:201-567-5000
Mailing Address - Fax:201-384-7067
Practice Address - Street 1:93 W PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2611
Practice Address - Country:US
Practice Address - Phone:201-567-5000
Practice Address - Fax:201-384-7067
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004379001041C0700X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ702807C2RMedicare ID - Type Unspecified