Healthcare Provider Details

I. General information

NPI: 1689947699
Provider Name (Legal Business Name): PHYLLIS IRENE PERRONE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7266 BUCKLEY RD
NORTH SYRACUSE NY
13212-2649
US

IV. Provider business mailing address

203 ONTARIO PL
LIVERPOOL NY
13088-5642
US

V. Phone/Fax

Practice location:
  • Phone: 315-458-0919
  • Fax: 315-458-0954
Mailing address:
  • Phone: 315-415-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number062537-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: