Healthcare Provider Details

I. General information

NPI: 1659109585
Provider Name (Legal Business Name): AUTUMN GEBHART LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 N SALINA ST
SYRACUSE NY
13203-1755
US

IV. Provider business mailing address

2150 S GEDDES ST
SYRACUSE NY
13207-1535
US

V. Phone/Fax

Practice location:
  • Phone: 315-471-1564
  • Fax:
Mailing address:
  • Phone: 315-415-0792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123837
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: