Healthcare Provider Details

I. General information

NPI: 1912557075
Provider Name (Legal Business Name): JOANNA SUE STERGION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MAIN ST
CORTLAND NY
13045-3049
US

IV. Provider business mailing address

165 MAIN ST
CORTLAND NY
13045-3049
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-0234
  • Fax: 607-753-0286
Mailing address:
  • Phone: 607-753-0234
  • Fax: 607-753-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number094977-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: