Healthcare Provider Details

I. General information

NPI: 1659953750
Provider Name (Legal Business Name): MAUREEN H WOPPERER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 JAMES ST STE 100
SYRACUSE NY
13203-2758
US

IV. Provider business mailing address

14 CROSSROADS DR
FULTON NY
13069-5009
US

V. Phone/Fax

Practice location:
  • Phone: 883-335-4237
  • Fax: 315-479-7884
Mailing address:
  • Phone: 315-425-1004
  • Fax: 315-883-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number112560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: