Provider Demographics
NPI:1790793206
Name:JOSEPH, BRENDA KATHLEEN I
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KATHLEEN
Last Name:JOSEPH
Suffix:I
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 1:306 E BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-2407
Mailing Address - Country:US
Mailing Address - Phone:765-585-6137
Mailing Address - Fax:317-674-0060
Practice Address - Street 1:948 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3722
Practice Address - Country:US
Practice Address - Phone:615-242-3576
Practice Address - Fax:615-226-5783
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IN34007701A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN150074Medicare ID - Type Unspecified