Provider Demographics
NPI:1619262540
Name:GIDES, JOEL A (MS)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:GIDES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 COLLEGE PARK PLAZA
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904
Mailing Address - Country:US
Mailing Address - Phone:814-262-0025
Mailing Address - Fax:814-266-8745
Practice Address - Street 1:214 COLLEGE PARK PLAZA
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904
Practice Address - Country:US
Practice Address - Phone:814-262-0025
Practice Address - Fax:814-266-8745
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006291101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health