Provider Demographics
NPI:1356985360
Name:ON, JOE RAYMOND (CASAC # 20936)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:RAYMOND
Last Name:ON
Suffix:
Gender:M
Credentials:CASAC # 20936
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:175 REMSEN ST STE 900
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4300
Mailing Address - Country:US
Mailing Address - Phone:718-858-6631
Mailing Address - Fax:347-689-4677
Practice Address - Street 1:175 REMSEN ST STE 900
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4300
Practice Address - Country:US
Practice Address - Phone:718-858-6631
Practice Address - Fax:347-689-4677
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)