Provider Demographics
NPI:1104827864
Name:MILISITZ, JOSEPH ANDREW (PHD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANDREW
Last Name:MILISITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 W PALMETTO PARK RD
Mailing Address - Street 2:# 310
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3330
Mailing Address - Country:US
Mailing Address - Phone:561-620-9797
Mailing Address - Fax:561-620-7848
Practice Address - Street 1:1499 W PALMETTO PARK RD
Practice Address - Street 2:# 172
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3328
Practice Address - Country:US
Practice Address - Phone:561-620-9797
Practice Address - Fax:561-620-7848
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 22451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2649AMedicare ID - Type Unspecified