Provider Demographics
NPI:1750844171
Name:DUCOS, JASON ANTHONY (LCSW, CASAC-MASTERS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ANTHONY
Last Name:DUCOS
Suffix:
Gender:M
Credentials:LCSW, CASAC-MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 E 15TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4319
Mailing Address - Country:US
Mailing Address - Phone:347-217-6252
Mailing Address - Fax:
Practice Address - Street 1:2294 E 15TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4319
Practice Address - Country:US
Practice Address - Phone:347-217-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31751101YA0400X
NY0869371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)