Provider Demographics
NPI:1184164378
Name:JOSEPH, CHARLES III (LISW-S)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:JOSEPH
Suffix:III
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4509 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-3427
Mailing Address - Country:US
Mailing Address - Phone:216-390-9558
Mailing Address - Fax:
Practice Address - Street 1:4509 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-3427
Practice Address - Country:US
Practice Address - Phone:216-390-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00056711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical