Healthcare Provider Details

I. General information

NPI: 1730403460
Provider Name (Legal Business Name): SCOTT P. PRANIS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N PARK ST SECOND FLOOR
SENECA FALLS NY
13148-1437
US

IV. Provider business mailing address

12 N PARK ST 2ND FLOOR
SENECA FALLS NY
13148-1437
US

V. Phone/Fax

Practice location:
  • Phone: 315-568-9412
  • Fax: 315-568-6718
Mailing address:
  • Phone: 315-568-9412
  • Fax: 315-568-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number077019
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: