Healthcare Provider Details

I. General information

NPI: 1205294501
Provider Name (Legal Business Name): DANA TARNACKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA COLLIER

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WHITESBORO ST
UTICA NY
13502-3015
US

IV. Provider business mailing address

518 JAMES ST
SYRACUSE NY
13203-2238
US

V. Phone/Fax

Practice location:
  • Phone: 315-724-5168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number41111
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18 P00528
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: