Healthcare Provider Details

I. General information

NPI: 1205181443
Provider Name (Legal Business Name): MARIA TANYA JOSEFORSKY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 OLD KEENE MILL RD
WEST SPRINGFIELD VA
22152-2302
US

IV. Provider business mailing address

PO BOX 9478
BRADENTON FL
34206-9478
US

V. Phone/Fax

Practice location:
  • Phone: 540-419-1728
  • Fax:
Mailing address:
  • Phone: 941-782-4100
  • Fax: 941-782-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: