Provider Demographics
NPI:1518279181
Name:QUEVEDO, JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:QUEVEDO
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 1:14791 OAK LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1518
Mailing Address - Country:US
Mailing Address - Phone:305-330-9977
Mailing Address - Fax:
Practice Address - Street 1:7815 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6541
Practice Address - Country:US
Practice Address - Phone:786-953-8712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103T00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor