Healthcare Provider Details

I. General information

NPI: 1861528010
Provider Name (Legal Business Name): SEMRA ZEYNEP KECELIOGLU L.C.S.W.-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 COPELAND AVE
HOMER NY
13077-1529
US

IV. Provider business mailing address

2 GLYNDON AVE
CORTLAND NY
13045-1114
US

V. Phone/Fax

Practice location:
  • Phone: 607-749-5711
  • Fax: 607-753-3165
Mailing address:
  • Phone: 607-745-5000
  • Fax: 607-753-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR073821-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: