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General NPI Number Information
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NPI Number | 1194542886
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Entity Type | Organization
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Legal Business Name | CULTIVATE CONNECTION MARRIAGE AND FAMILY THERAPY PLLC
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Dates
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Enumeration Date | 09/24/2024
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 601 ALLEN ST
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City | SYRACUSE
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State | NY
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Zip | 13210-2669
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Country | US
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Telephone | 315-552-1665
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Fax | 844-604-6200
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Provider Business Mailing Address
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Address Line | 302 WEDGEWOOD TER
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City | SYRACUSE
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State | NY
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Zip | 13214-1544
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Country | US
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Telephone | 315-552-1665
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Fax | 844-604-6200
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Authorized Official
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Title or Position | OWNER
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Name | SARAH DEDRICK
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Credential | LMFT-D
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Telephone | 315-552-1665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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