Provider Demographics
NPI:1609864636
Name:TAYLOR, HENRY AUGUSTUS (PHD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:AUGUSTUS
Last Name:TAYLOR
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 1:111 QUIMBY ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2185
Mailing Address - Country:US
Mailing Address - Phone:908-654-9700
Mailing Address - Fax:908-654-9150
Practice Address - Street 1:111 QUIMBY ST
Practice Address - Street 2:SUITE 6
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2185
Practice Address - Country:US
Practice Address - Phone:908-654-9700
Practice Address - Fax:908-654-9150
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00118400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ449823Medicare ID - Type Unspecified