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General NPI Number Information
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NPI Number | 1114262375
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Entity Type | Individual
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Provider Name | CHRISTOPHER P. CEDERQUIST MSW
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Gender | Male
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 6836 E GENESEE ST
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-1024
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Country | US
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Telephone | 315-440-3166
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Fax |
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Provider Business Mailing Address
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Address Line | 2616 FENNER RD
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City | CAZENOVIA
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State | NY
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Zip | 13035-9702
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Country | US
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Telephone | 315-440-3166
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Fax |
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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 | R032616-1
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License Number State | NY
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