Provider Demographics
NPI:1609122704
Name:JOSEPH, ANTHONY NICODEMUS (MSW)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:NICODEMUS
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 PINEBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-1827
Mailing Address - Country:US
Mailing Address - Phone:646-294-3696
Mailing Address - Fax:
Practice Address - Street 1:1055 PINEBROOK BLVD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-1827
Practice Address - Country:US
Practice Address - Phone:646-294-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY843431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXXXXXXXXXXMedicaid