MEDICARE: JOEL KOUAME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1598302549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOEL KOUAME

Provider Business Mailing Address
First Line	:	3110 37TH AVE STE 401
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2112
Country	:	US
Telephone Number	:	646-883-5911
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 37TH AVE STE 401
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2112
Country	:	US
Telephone Number	:	646-883-5911
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOEL KOUAME
Credential	:	LCSW
Telephone Number	:	646-883-5911

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	03/15/2023

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