Provider Demographics
NPI:1912286626
Name:JAGATIC, GEORGE M (MS, R-DMT, LCAT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:M
Last Name:JAGATIC
Suffix:
Gender:M
Credentials:MS, R-DMT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 FULTON ST APT 7H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-2653
Mailing Address - Country:US
Mailing Address - Phone:917-257-4532
Mailing Address - Fax:
Practice Address - Street 1:451 CLARKSON AVE. KINGS COUNTY HOSPITAL
Practice Address - Street 2:OFFICE AG74
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-245-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCAT001345-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health