Provider Demographics
NPI:1427471317
Name:MIRWIS, JOSHUA ELLIOT (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ELLIOT
Last Name:MIRWIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 TRANSIT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051
Mailing Address - Country:US
Mailing Address - Phone:716-204-2760
Mailing Address - Fax:716-204-2761
Practice Address - Street 1:6507 TRANSIT RD
Practice Address - Street 2:SUITE B
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051
Practice Address - Country:US
Practice Address - Phone:716-204-2760
Practice Address - Fax:716-204-2761
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020411103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool