Provider Demographics
NPI:1982990347
Name:EGEDE, SR, JAMES CHUKUEMEKE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHUKUEMEKE
Last Name:EGEDE, SR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PARK AVE FL 25
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5550
Mailing Address - Country:US
Mailing Address - Phone:718-352-3703
Mailing Address - Fax:718-352-7495
Practice Address - Street 1:125 PARK AVE FL 25
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5550
Practice Address - Country:US
Practice Address - Phone:646-982-0906
Practice Address - Fax:718-352-7495
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004054-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health