Provider Demographics
NPI:1821601451
Name:CRAIG, JOSHUA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:CRAIG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 CHICAGO AVE STE M17
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2033
Mailing Address - Country:US
Mailing Address - Phone:310-696-9019
Mailing Address - Fax:
Practice Address - Street 1:1660 CHICAGO AVE STE M17
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2033
Practice Address - Country:US
Practice Address - Phone:310-696-9019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30442103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic