Provider Demographics
NPI:1629202072
Name:CRAMER, GEORGINA MERCEDES (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GEORGINA
Middle Name:MERCEDES
Last Name:CRAMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1586
Mailing Address - Country:US
Mailing Address - Phone:631-348-5037
Mailing Address - Fax:631-348-5163
Practice Address - Street 1:299 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1586
Practice Address - Country:US
Practice Address - Phone:631-348-5037
Practice Address - Fax:631-348-5163
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054430104100000X
NY730804121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY73080412Medicaid