Provider Demographics
NPI:1124293428
Name:PRYOR, GREGORY J (LCSW, LCADC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:J
Last Name:PRYOR
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:302A BARTON RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:609-280-6998
Mailing Address - Fax:856-983-1511
Practice Address - Street 1:401 NORTH ROUTE 73
Practice Address - Street 2:BUILDING 10, SUITE 110
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:609-280-6998
Practice Address - Fax:856-983-1511
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00025400101YA0400X
NJ44SC052656001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)