Provider Demographics
NPI:1114909231
Name:WAX, JEFFREY H (LCSWR)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:H
Last Name:WAX
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BROADWAY
Mailing Address - Street 2:LEAGUE FOR THE HARD OF HEARING
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-3810
Mailing Address - Country:US
Mailing Address - Phone:917-305-7739
Mailing Address - Fax:917-305-7888
Practice Address - Street 1:50 BROADWAY
Practice Address - Street 2:LEAGUE FOR THE HARD OF HEARING
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1607
Practice Address - Country:US
Practice Address - Phone:917-305-7739
Practice Address - Fax:917-305-7888
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04974311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN000Y1Medicare ID - Type Unspecified