Provider Demographics
NPI:1982826202
Name:GARRY, JOSEPH VINCENT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:VINCENT
Last Name:GARRY
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 1:31 WASHINGTON W SQ 6F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9126
Mailing Address - Country:US
Mailing Address - Phone:212-260-4052
Mailing Address - Fax:212-260-4052
Practice Address - Street 1:31 WASHINGTON SQ W
Practice Address - Street 2:6F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9126
Practice Address - Country:US
Practice Address - Phone:212-260-4052
Practice Address - Fax:212-260-4052
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0734881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY073488OtherLCSW LICENSE NUMBER
NY9774116OtherAETNA