Healthcare Provider Details

I. General information

NPI: 1548405749
Provider Name (Legal Business Name): CHERYL ANNE THURSTON RN, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CLAYTON AVE
CORTLAND NY
13045-2501
US

IV. Provider business mailing address

930 ROUTE 11A
TULLY NY
13159
US

V. Phone/Fax

Practice location:
  • Phone: 607-758-6100
  • Fax: 607-758-6116
Mailing address:
  • Phone: 315-696-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number061557-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number328935-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: