Provider Demographics
NPI:1437602802
Name:JOSEPH, RAJEEV RONALD (MED (SPECIAL ED))
Entity Type:Individual
Prefix:
First Name:RAJEEV
Middle Name:RONALD
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MED (SPECIAL ED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MONTEREY OAKS BLVD APT 2217
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4363
Mailing Address - Country:US
Mailing Address - Phone:512-947-0549
Mailing Address - Fax:
Practice Address - Street 1:4600 MONTEREY OAKS BLVD APT 2217
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4363
Practice Address - Country:US
Practice Address - Phone:512-947-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-16-22252103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRBT-16-22252OtherBACB