Provider Demographics
NPI:1215984125
Name:KATZ, JERRY S (LCSW)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:S
Last Name:KATZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 80TH ST
Mailing Address - Street 2:APT.52
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2705
Mailing Address - Country:US
Mailing Address - Phone:917-359-5375
Mailing Address - Fax:718-424-2776
Practice Address - Street 1:347 5TH AVE
Practice Address - Street 2:RM.1401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5010
Practice Address - Country:US
Practice Address - Phone:917-359-5375
Practice Address - Fax:718-424-2776
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0385831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR038583OtherSTATE LICENSE
P1223060OtherOXFORD
N44892Medicare ID - Type UnspecifiedMEDICARE