Provider Demographics
NPI:1841756111
Name:JOSEPH, KATHLEEN (MED/EDS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MED/EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10541 NW 31ST PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7534
Mailing Address - Country:US
Mailing Address - Phone:352-246-3693
Mailing Address - Fax:
Practice Address - Street 1:1225 NW 10TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4154
Practice Address - Country:US
Practice Address - Phone:352-246-3693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health