MEDICARE: MS. JOANNE G KLAGES 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	1041C0700X	Clinical Social Worker	44SC04986100	NJ
2	1041C0700X	Clinical Social Worker	RO21132-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	498021	OTHER	NY	VALUE OPTIONS

General Provider Information

NPI Number	:	1518153303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOANNE G KLAGES LCSW

Provider Business Mailing Address
First Line	:	127 MAIN ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1226
Country	:	US
Telephone Number	:	718-966-5255
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 MAIN ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1226
Country	:	US
Telephone Number	:	718-966-5255
Fax Number	:

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

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	07/14/2008

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