Provider Demographics
NPI:1013207919
Name:EGE, JOSEPH (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:EGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3584 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1006
Mailing Address - Country:US
Mailing Address - Phone:718-653-1537
Mailing Address - Fax:718-882-1426
Practice Address - Street 1:116 W 23RD STREET
Practice Address - Street 2:SUITE 500 ROOM 14
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2599
Practice Address - Country:US
Practice Address - Phone:917-476-4638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29699101YA0400X
NY0839411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03008211Medicaid