Provider Demographics
NPI:1063666774
Name:CERMAK, JOSEPH L (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:CERMAK
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1572
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1364
Mailing Address - Country:US
Mailing Address - Phone:770-591-9552
Mailing Address - Fax:770-516-4191
Practice Address - Street 1:335 PARKWAY 575
Practice Address - Street 2:SUITE #220
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6433
Practice Address - Country:US
Practice Address - Phone:770-591-9552
Practice Address - Fax:770-516-4191
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst