Provider Demographics
NPI:1942241757
Name:MUSHABAC, JOY GABRIELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:GABRIELLE
Last Name:MUSHABAC
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 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4508
Mailing Address - Country:US
Mailing Address - Phone:607-427-1840
Mailing Address - Fax:
Practice Address - Street 1:35 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4508
Practice Address - Country:US
Practice Address - Phone:607-427-1840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0388981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132080OtherVALUE OPTIONS CDPHP
NY7404904OtherVALUE OPTIONS EMPIRE GHI
NY005495000OtherMAGELLAN BEHAVIORAL HEALT
NY618815OtherMVP
NY300693OtherMHN
NY5576750OtherAETNA
NY571229852OtherEXCELLUS BCBS CENTRAL NY
55272HMedicare PIN