Provider Demographics
NPI:1679648075
Name:JONG, JOANNA GILLIES (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:GILLIES
Last Name:JONG
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 1:35 E 85TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0954
Mailing Address - Country:US
Mailing Address - Phone:212-734-0866
Mailing Address - Fax:212-734-0866
Practice Address - Street 1:120 W 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3320
Practice Address - Country:US
Practice Address - Phone:212-632-4770
Practice Address - Fax:212-632-4534
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO47285-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical