Healthcare Provider Details

I. General information

NPI: 1922724996
Provider Name (Legal Business Name): MARY GIDNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 N SALINA ST
SYRACUSE NY
13203-1755
US

IV. Provider business mailing address

703 WEBBER DR
CHITTENANGO NY
13037-1127
US

V. Phone/Fax

Practice location:
  • Phone: 315-434-5333
  • Fax: 315-434-5335
Mailing address:
  • Phone: 518-578-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39797
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: