Provider Demographics
NPI:1760676225
Name:LAGOS, GERARD M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:M
Last Name:LAGOS
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 1:886 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2573
Mailing Address - Country:US
Mailing Address - Phone:973-423-3983
Mailing Address - Fax:201-485-8241
Practice Address - Street 1:886 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2573
Practice Address - Country:US
Practice Address - Phone:973-423-3983
Practice Address - Fax:201-485-8241
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045833001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ652776Medicare PIN