Provider Demographics
NPI:1093479594
Name:JOSAPHAT, IVELOUSE E (MA)
Entity Type:Individual
Prefix:
First Name:IVELOUSE
Middle Name:E
Last Name:JOSAPHAT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-2813
Mailing Address - Country:US
Mailing Address - Phone:646-339-6167
Mailing Address - Fax:
Practice Address - Street 1:1112 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-2813
Practice Address - Country:US
Practice Address - Phone:646-339-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty