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NPI Code Detail

MEDICARE: BREANNA KATE FINNERON BUCKLEY LCSW

MEDICARE: BREANNA KATE FINNERON BUCKLEY 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
1104100000XSocial Worker
21041C0700XClinical Social Worker094869NY

General Provider Information

NPI Number : 1265613046
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA KATE FINNERON BUCKLEY LCSW
Provider Business Mailing Address
First Line : 329 N SALINA ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13203-1755
Country : US
Telephone Number : 315-471-1564
Fax Number : 315-396-0114
Provider Business Practice Location Address
First Line : 329 N SALINA ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13203-1755
Country : US
Telephone Number : 315-471-1564
Fax Number : 315-396-0114
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2007
Last Update Date : 03/29/2024

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