Provider Demographics
NPI:1447523162
Name:WALDRON, JOSEPH LEE (BCABA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEE
Last Name:WALDRON
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 GATEWAY BLVD
Mailing Address - Street 2:APT. 1522
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2671
Mailing Address - Country:US
Mailing Address - Phone:210-827-3462
Mailing Address - Fax:
Practice Address - Street 1:265 E LULLWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5268
Practice Address - Country:US
Practice Address - Phone:210-680-8737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-11-4365103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst