Provider Demographics
NPI:1104169846
Name:JOSEPH, DEBRA SUSAN (PSYD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUSAN
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E CAMELBACK RD
Mailing Address - Street 2:#155
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4309
Mailing Address - Country:US
Mailing Address - Phone:602-230-7373
Mailing Address - Fax:602-682-7455
Practice Address - Street 1:2701 E CAMELBACK RD
Practice Address - Street 2:#155
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4309
Practice Address - Country:US
Practice Address - Phone:602-230-7373
Practice Address - Fax:602-682-7455
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical