Healthcare Provider Details

I. General information

NPI: 1972017614
Provider Name (Legal Business Name): LINDSAY COONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 JAMES STREET
SYRACUSE NY
13203
US

IV. Provider business mailing address

635 JAMES STREET
SYRACUSE NY
13203
US

V. Phone/Fax

Practice location:
  • Phone: 315-857-3533
  • Fax:
Mailing address:
  • Phone: 315-857-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number107215-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: