Provider Demographics
NPI:1083048664
Name:JOSEPH, GERARD MICHAEL (BA)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:MICHAEL
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:BA
Other - Prefix:MR
Other - First Name:GERARD
Other - Middle Name:MICHAEL
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:647 34TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-3730
Mailing Address - Country:US
Mailing Address - Phone:727-824-5745
Mailing Address - Fax:
Practice Address - Street 1:647 34TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3730
Practice Address - Country:US
Practice Address - Phone:727-824-5745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health