Healthcare Provider Details

I. General information

NPI: 1295068724
Provider Name (Legal Business Name): DEVEREUX ASSOCIATES, LCSW P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 DEVEREUX ST. 4TH FLOOR
UTICA NY
13501
US

IV. Provider business mailing address

11 DEVEREUX ST. 4TH FLOOR
UTICA NY
13501
US

V. Phone/Fax

Practice location:
  • Phone: 315-269-1037
  • Fax:
Mailing address:
  • Phone: 315-269-1037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075350
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number075350
License Number StateNY

VIII. Authorized Official

Name: MR. CHARLES ARNOLD ZELOWS
Title or Position: VICE PRESIDENT
Credential: LCSW
Phone: 315-269-1037