Provider Demographics
NPI:1801833116
Name:JOSEPH, THOMAS X (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:X
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 HEATHERSTONE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4828
Mailing Address - Country:US
Mailing Address - Phone:540-702-8573
Mailing Address - Fax:
Practice Address - Street 1:1133 HEATHERSTONE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4828
Practice Address - Country:US
Practice Address - Phone:540-702-8573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002447103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA289795OtherANTHEM
VA457148OtherVALUE OPTIONS
VAP45986Medicare UPIN
VA00X364P01Medicare PIN