Provider Demographics
NPI:1487334678
Name:JOSEPH, CARL JEFFERSON
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:JEFFERSON
Last Name:JOSEPH
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 1:232 BIDWELL AVE APT 45
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3394
Mailing Address - Country:US
Mailing Address - Phone:786-794-3127
Mailing Address - Fax:
Practice Address - Street 1:1 DEGRAW AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4094
Practice Address - Country:US
Practice Address - Phone:973-910-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician