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NPI Code Detail

MEDICARE: KAREN STOCKER LAQUIDARI LCSW

MEDICARE: KAREN STOCKER LAQUIDARI 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
11041C0700XClinical Social WorkerR027199-01NY

General Provider Information

NPI Number : 1477174373
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN STOCKER LAQUIDARI LCSW
Provider Business Mailing Address
First Line : 823 VINE ST
Second Line :
City : LIVERPOOL
State : NY
Zip : 13088-5229
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5075 W SENECA TPKE
Second Line :
City : SYRACUSE
State : NY
Zip : 13215-3216
Country : US
Telephone Number : 718-506-1115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2020
Last Update Date : 05/01/2020

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