Provider Demographics
NPI:1487305694
Name:GEGA, MEDIHA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MEDIHA
Middle Name:
Last Name:GEGA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEDIHA
Other - Middle Name:
Other - Last Name:KOSOVRASTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3520 LEVERICH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3951
Mailing Address - Country:US
Mailing Address - Phone:609-954-5381
Mailing Address - Fax:
Practice Address - Street 1:3520 LEVERICH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3951
Practice Address - Country:US
Practice Address - Phone:609-954-5381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA127555104100000X
CT12869104100000X
NY085286-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
085286-01OtherNY STATE LCSW LICENSE NUMBER