MEDICARE: MS. MEDIHA GEGA LCSW

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	104100000X	Social Worker	127555	MA
2	104100000X	Social Worker	12869	CT
3	1041C0700X	Clinical Social Worker	085286-01	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085286-01	OTHER		NY STATE LCSW LICENSE NUMBER

General Provider Information

NPI Number	:	1487305694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MEDIHA GEGA LCSW

Provider Business Mailing Address
First Line	:	3520 LEVERICH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-3951
Country	:	US
Telephone Number	:	609-954-5381
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 LEVERICH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-3951
Country	:	US
Telephone Number	:	609-954-5381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2022
Last Update Date	:	03/04/2024

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