Healthcare Provider Details

I. General information

NPI: 1235184235
Provider Name (Legal Business Name): ONONDAGA CASE MANAGEMENT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/16/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 ERIE BLVD W STE 302
SYRACUSE NY
13204-2463
US

IV. Provider business mailing address

620 ERIE BLVD W STE 302
SYRACUSE NY
13204-2463
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-7363
  • Fax: 315-472-0084
Mailing address:
  • Phone: 315-472-7363
  • Fax: 315-472-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberVARIOUS THERAPISTS
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberVARIOUS
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberVARIOUS LICENSES
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberNOT LICENSED IN NYS
License Number StateNY

VIII. Authorized Official

Name: MR. SCOTT EBNER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 315-472-7363