Provider Demographics
NPI:1336570258
Name:WISEHEART, JOSEPHINE KATHRYN (MS, LMFT, LMHC)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:KATHRYN
Last Name:WISEHEART
Suffix:
Gender:F
Credentials:MS, LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 SW 57TH AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5408
Mailing Address - Country:US
Mailing Address - Phone:305-663-1288
Mailing Address - Fax:
Practice Address - Street 1:7600 SW 57TH AVE STE 222
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5408
Practice Address - Country:US
Practice Address - Phone:305-663-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3189106H00000X
FLMH14276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL591788265OtherEIN