Provider Demographics
NPI:1285254268
Name:JOSEPH, WIRDYNE (BS)
Entity type:Individual
Prefix:
First Name:WIRDYNE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 NE 1ST CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-2347
Mailing Address - Country:US
Mailing Address - Phone:561-654-5854
Mailing Address - Fax:
Practice Address - Street 1:816 W CANAL ST S
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-2942
Practice Address - Country:US
Practice Address - Phone:561-654-5854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor