Provider Demographics
NPI:1245384809
Name:AVERY, JOSEPH (BS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:AVERY
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19206 MIDTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746
Mailing Address - Country:US
Mailing Address - Phone:323-226-8826
Mailing Address - Fax:323-226-2992
Practice Address - Street 1:4235 EAST COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221
Practice Address - Country:US
Practice Address - Phone:310-509-3764
Practice Address - Fax:310-632-0356
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225400000XOtherMH REHABILITATION SPECIAL