Healthcare Provider Details

I. General information

NPI: 1982106977
Provider Name (Legal Business Name): JOHN ALAN METZGER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 CHURCH AVENUE
GERMANTOWN NY
12526
US

IV. Provider business mailing address

588 CHURCH AVENUE
GERMANTOWN NY
12526
US

V. Phone/Fax

Practice location:
  • Phone: 518-532-2221
  • Fax:
Mailing address:
  • Phone: 518-537-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number086033-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: