Healthcare Provider Details

I. General information

NPI: 1255442687
Provider Name (Legal Business Name): SAL VILLANO SOCIAL WORK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SYRACUSE VA MEDICAL CENTER 800 IRVING AVE
SYRACUSE NY
13210-2645
US

IV. Provider business mailing address

119 CLARKE ST
SYRACUSE NY
13210-2645
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-4400
  • Fax: 315-425-3447
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number018758-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: