Provider Demographics
NPI:1538645585
Name:JOSEPH, MURIELLE NADINE
Entity Type:Individual
Prefix:
First Name:MURIELLE
Middle Name:NADINE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 FOREST CLUB DR APT 313
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7908
Mailing Address - Country:US
Mailing Address - Phone:516-698-2017
Mailing Address - Fax:
Practice Address - Street 1:711 FOREST CLUB DR APT 313
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-7908
Practice Address - Country:US
Practice Address - Phone:516-698-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPB0718618280106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst