Provider Demographics
NPI:1376830695
Name:JOSEPH, ANDRONIQUE (MED)
Entity Type:Individual
Prefix:MS
First Name:ANDRONIQUE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3219
Mailing Address - Country:US
Mailing Address - Phone:617-516-0280
Mailing Address - Fax:617-516-0281
Practice Address - Street 1:1960 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3219
Practice Address - Country:US
Practice Address - Phone:617-516-0280
Practice Address - Fax:617-516-0281
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health