Healthcare Provider Details

I. General information

NPI: 1376775817
Provider Name (Legal Business Name): MARK H. OKAZAKI LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 W ONONDAGA ST SUITE 24
SYRACUSE NY
13202-1888
US

IV. Provider business mailing address

375 W ONONDAGA ST SUITE 24
SYRACUSE NY
13202-1888
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-0610
  • Fax: 315-478-2510
Mailing address:
  • Phone: 315-478-0610
  • Fax: 315-478-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: