Provider Demographics
NPI:1710559281
Name:JOSAIAH, MIRA-CLER JOY
Entity Type:Individual
Prefix:
First Name:MIRA-CLER
Middle Name:JOY
Last Name:JOSAIAH
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 1:2616 MAHOGANY DR APT 73
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4794
Mailing Address - Country:US
Mailing Address - Phone:847-910-4692
Mailing Address - Fax:
Practice Address - Street 1:4200 CONESTOGA DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7934
Practice Address - Country:US
Practice Address - Phone:630-286-0026
Practice Address - Fax:847-908-7541
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician