Provider Demographics
NPI:1811141377
Name:JOSEPH, MIRIAM J (LCSW-R)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:J
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WOODBINE ST
Mailing Address - Street 2:# 1
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3611
Mailing Address - Country:US
Mailing Address - Phone:917-513-9334
Mailing Address - Fax:
Practice Address - Street 1:1701 WOODBINE ST
Practice Address - Street 2:# 1
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3611
Practice Address - Country:US
Practice Address - Phone:917-513-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0502391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical