Provider Demographics
NPI:1528232220
Name:JOSEPH, CLEVELAND SHELTON (CASAC)
Entity Type:Individual
Prefix:MR
First Name:CLEVELAND
Middle Name:SHELTON
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 FURMAN AVE APT 4H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1544
Mailing Address - Country:US
Mailing Address - Phone:347-346-9278
Mailing Address - Fax:347-346-9278
Practice Address - Street 1:4360 FURMAN AVE APT 4H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1544
Practice Address - Country:US
Practice Address - Phone:347-346-9278
Practice Address - Fax:347-346-9278
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101777261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health