Provider Demographics
NPI:1578217337
Name:JOSEPH, JESSICA NICOLE (HEALTH CARE PROVIDER)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:NICOLE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:HEALTH CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 LACOMBE AVE APT 8I
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1625
Mailing Address - Country:US
Mailing Address - Phone:347-955-6117
Mailing Address - Fax:
Practice Address - Street 1:2175 LACOMBE AVE APT 8I
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-1625
Practice Address - Country:US
Practice Address - Phone:347-955-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health