Provider Demographics
NPI:1992170096
Name:NG, JOSEPH (MA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 639561
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9561
Mailing Address - Country:US
Mailing Address - Phone:844-247-7222
Mailing Address - Fax:215-489-8766
Practice Address - Street 1:3130 CHATHAM RD STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-5379
Practice Address - Country:US
Practice Address - Phone:844-247-7222
Practice Address - Fax:215-489-8766
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-17-28142103K00000X
CA1-17-28142103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst