Provider Demographics
NPI:1639474703
Name:QUEZADA, JOSEPH LEE (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LEE
Last Name:QUEZADA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:LEE
Other - Last Name:QUEZADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:1218 GRIEGOS RD NW, 87107
Mailing Address - Street 2:HOGARES INC
Mailing Address - City:ALBUQURQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87101
Mailing Address - Country:US
Mailing Address - Phone:505-274-9796
Mailing Address - Fax:505-891-3217
Practice Address - Street 1:1218 GRIEGOS RD NW
Practice Address - Street 2:1218 GRIEGOS RD NW
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3752
Practice Address - Country:US
Practice Address - Phone:505-274-9796
Practice Address - Fax:505-891-3217
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst