Provider Demographics
NPI:1184331837
Name:FEDERICO, JOYCE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:FEDERICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 WOODLOT RD
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-1908
Mailing Address - Country:US
Mailing Address - Phone:646-246-2473
Mailing Address - Fax:
Practice Address - Street 1:59 WOODLOT RD
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-1908
Practice Address - Country:US
Practice Address - Phone:646-246-2473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY891131405300000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No405300000XOther Service ProvidersPrevention Professional