Provider Demographics
NPI:1881326973
Name:BLISS, JOSHUA DILLON
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DILLON
Last Name:BLISS
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 1:19215 NW 50TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2038
Mailing Address - Country:US
Mailing Address - Phone:305-343-0349
Mailing Address - Fax:
Practice Address - Street 1:15165 NW 77TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7801
Practice Address - Country:US
Practice Address - Phone:305-828-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician