Provider Demographics
NPI:1194947838
Name:DEGEORGE, FLORA MARTINS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:FLORA
Middle Name:MARTINS
Last Name:DEGEORGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5945
Mailing Address - Country:US
Mailing Address - Phone:973-538-2360
Mailing Address - Fax:
Practice Address - Street 1:215 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1355
Practice Address - Country:US
Practice Address - Phone:917-535-4461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052772001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3639315OtherOXFORD HEATH PLANS