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General NPI Number Information
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NPI Number | 1083621726
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Entity Type | Individual
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Provider Name | ROBERT JONATHAN BALL LCSW, ED.D.
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1212 JAMES ST
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City | SYRACUSE
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State | NY
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Zip | 13203-2808
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Country | US
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Telephone | 315-428-8844
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Fax | 315-428-8304
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Provider Business Mailing Address
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Address Line | 5730 E LAKE RD
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City | CAZENOVIA
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State | NY
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Zip | 13035-9324
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Country | US
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Telephone | 315-655-3671
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Fax | 315-428-8304
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R034319-1
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License Number State | NY
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