Provider Demographics
NPI:1679091193
Name:JOSEPH, BRIAN ANTHONY SR
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ANTHONY
Last Name:JOSEPH
Suffix:SR
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 1:11400 S EASTERLYN CIR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-5204
Mailing Address - Country:US
Mailing Address - Phone:504-234-9284
Mailing Address - Fax:
Practice Address - Street 1:4480 GENERAL DEGAULLE DR STE 206
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-6309
Practice Address - Country:US
Practice Address - Phone:504-905-6945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA47-2964148Medicaid