Provider Demographics
NPI:1902041817
Name:COX, CHARLES E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:COX
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 1:405 RXR PLZ
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-3811
Mailing Address - Country:US
Mailing Address - Phone:646-265-9051
Mailing Address - Fax:
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:STE 310
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3110
Practice Address - Country:US
Practice Address - Phone:646-265-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0808811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03165675Medicaid
NYA300145353OtherMEDICARE