Provider Demographics
NPI:1033392790
Name:VISPERAS, JOSHUA SCOTT
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SCOTT
Last Name:VISPERAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 WARRING DR APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2857
Mailing Address - Country:US
Mailing Address - Phone:408-206-5004
Mailing Address - Fax:
Practice Address - Street 1:784 WARRING DR APT 3
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2857
Practice Address - Country:US
Practice Address - Phone:408-206-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health