Healthcare Provider Details

I. General information

NPI: 1760488738
Provider Name (Legal Business Name): JEFFREY DREW C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 SEDGWICK DR
SYRACUSE NY
13203-1132
US

IV. Provider business mailing address

523 SEDGWICK DR
SYRACUSE NY
13203-1132
US

V. Phone/Fax

Practice location:
  • Phone: 315-474-1925
  • Fax:
Mailing address:
  • Phone: 315-474-1925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: