Provider Demographics
NPI:1497401962
Name:JOSEPHSON, BRUCE R
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:R
Last Name:JOSEPHSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6506 TOPAZ DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-7461
Mailing Address - Country:US
Mailing Address - Phone:682-433-6607
Mailing Address - Fax:
Practice Address - Street 1:6506 TOPAZ DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-7461
Practice Address - Country:US
Practice Address - Phone:682-433-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSD635104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker