Healthcare Provider Details

I. General information

NPI: 1386238988
Provider Name (Legal Business Name): JOY JEGEDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 05/26/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 BOSTON POST ROAD SUITE 3 PMB 757
MILFORD CT
06460
US

IV. Provider business mailing address

415 BOSTON POST ROAD SUITE 3 PMB 757
MILFORD CT
06460
US

V. Phone/Fax

Practice location:
  • Phone: 929-326-3509
  • Fax:
Mailing address:
  • Phone: 929-326-3509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOY JEGEDE
Title or Position: THERAPIST
Credential: LCSW
Phone: 929-326-3509