Basic Information
| Provider Information | |||||||||
| NPI: | 1013207919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EGE | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3584 JEROME AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104671006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186531537 | ||||||||
| FaxNumber: | 7188821426 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 W 23RD STREET | ||||||||
| Address2: | SUITE 500 ROOM 14 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100112599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9174764638 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 29699 | NY | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 083941 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 03008211 | 05 | NY | MEDICAID |