Provider Demographics
NPI:1003432188
Name:JOSEPHSON, DEMAREE K (PHD)
Entity type:Individual
Prefix:
First Name:DEMAREE
Middle Name:K
Last Name:JOSEPHSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 LEWISTON DR
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3013
Mailing Address - Country:US
Mailing Address - Phone:513-312-7415
Mailing Address - Fax:
Practice Address - Street 1:214 N CLAY AVE STE 215
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4068
Practice Address - Country:US
Practice Address - Phone:513-312-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351002678103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty