Provider Demographics
NPI:1669584744
Name:DEGEORGE, JOSEPH (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:DEGEORGE
Suffix:
Gender:M
Credentials:PHD, LCSW
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 244177
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33424-4177
Mailing Address - Country:US
Mailing Address - Phone:561-738-5000
Mailing Address - Fax:561-734-4804
Practice Address - Street 1:2500 QUANTUM LAKES DR
Practice Address - Street 2:SUITE 203
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8324
Practice Address - Country:US
Practice Address - Phone:561-738-5000
Practice Address - Fax:561-734-4804
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6381041C0700X
FLMT 574106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00302931OtherRAILROAD MEDICARE
FLR03684Medicare UPIN
FLP00302931OtherRAILROAD MEDICARE