Provider Demographics
NPI:1043956733
Name:JEROME, JOSEPH (BT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:JEROME
Suffix:
Gender:M
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LAURA DR
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1998
Mailing Address - Country:US
Mailing Address - Phone:989-763-3653
Mailing Address - Fax:
Practice Address - Street 1:109 LAURA DR
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1998
Practice Address - Country:US
Practice Address - Phone:989-763-3653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician