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NPI Code Detail

MEDICARE: JOSEPH ARCHIE LSW

MEDICARE: JOSEPH ARCHIE LSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1558829226
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH ARCHIE LSW
Provider Business Mailing Address
First Line : 11 W MONUMENT AVE FL 7
Second Line :
City : DAYTON
State : OH
Zip : 45402-1274
Country : US
Telephone Number : 937-461-4300
Fax Number :
Provider Business Practice Location Address
First Line : 1404 GASCHO DR
Second Line :
City : DAYTON
State : OH
Zip : 45410-3305
Country : US
Telephone Number : 937-252-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2019
Last Update Date : 03/12/2019

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Directions to “ JOSEPH ARCHIE LSW” Practice Location

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