Healthcare Provider Details

I. General information

NPI: 1710784913
Provider Name (Legal Business Name): LYNDSEY DERAE JOSEPH MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8577 E MARKET ST
WARREN OH
44484-2345
US

IV. Provider business mailing address

745 CARLIN DR
YOUNGSTOWN OH
44515-1206
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-6663
  • Fax: 330-856-1581
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0038694
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: