Provider Demographics
NPI:1316153133
Name:ENGRAM, JOYCE CLARK (CASAC #8157)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:CLARK
Last Name:ENGRAM
Suffix:
Gender:F
Credentials:CASAC #8157
Other - Prefix:MRS
Other - First Name:JOYCE
Other - Middle Name:CLARK
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CASAC #8157
Mailing Address - Street 1:166 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12202-1832
Mailing Address - Country:US
Mailing Address - Phone:518-449-5170
Mailing Address - Fax:518-598-0493
Practice Address - Street 1:64 2ND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-1240
Practice Address - Country:US
Practice Address - Phone:518-449-5170
Practice Address - Fax:518-598-0493
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8157101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)