Provider Demographics
NPI:1780618595
Name:ALPER, JOSEPH S (PHD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:ALPER
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 1:2008 SCOTTSDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-7641
Mailing Address - Country:US
Mailing Address - Phone:217-840-4208
Mailing Address - Fax:
Practice Address - Street 1:2008 SCOTTSDALE DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-7641
Practice Address - Country:US
Practice Address - Phone:217-840-4208
Practice Address - Fax:888-958-1846
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002452103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6447860011Medicare NSC
IL953830Medicare PIN
ILP30267Medicare UPIN
IL0533210001Medicare NSC
P30267Medicare UPIN
ILIL3270349Medicare PIN