Provider Demographics
NPI:1346748696
Name:CLUE, JOSHUA BENJAMIN
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BENJAMIN
Last Name:CLUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 MEADOWCREST ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4814
Mailing Address - Country:US
Mailing Address - Phone:540-336-4897
Mailing Address - Fax:
Practice Address - Street 1:3433 BRAMBLETON AVE # 101A
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6515
Practice Address - Country:US
Practice Address - Phone:540-283-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst