Provider Demographics
NPI:1457696536
Name:NDEGE, JOYCE W (LSW)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:W
Last Name:NDEGE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4670
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43058-4670
Mailing Address - Country:US
Mailing Address - Phone:740-788-0265
Mailing Address - Fax:740-788-3424
Practice Address - Street 1:1445 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1989
Practice Address - Country:US
Practice Address - Phone:740-522-8477
Practice Address - Fax:740-788-3424
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0600787104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200008Medicaid