Provider Demographics
NPI:1386238988
Name:JOY JEGEDE
Entity type:Organization
Organization Name:JOY JEGEDE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEGEDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:929-326-3509
Mailing Address - Street 1:415 BOSTON POST ROAD
Mailing Address - Street 2:SUITE 3 PMB 757
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:929-326-3509
Mailing Address - Fax:
Practice Address - Street 1:415 BOSTON POST ROAD
Practice Address - Street 2:SUITE 3 PMB 757
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:929-326-3509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health