Provider Demographics
NPI:1861998478
Name:JOSEPH, AMEENAH QAADIRA
Entity type:Individual
Prefix:
First Name:AMEENAH
Middle Name:QAADIRA
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 HEATHERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-5816
Mailing Address - Country:US
Mailing Address - Phone:614-800-1770
Mailing Address - Fax:
Practice Address - Street 1:3803 HEATHERGLEN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-5816
Practice Address - Country:US
Practice Address - Phone:614-800-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician