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General NPI Number Information
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NPI Number | 1275199291
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Entity Type | Organization
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Legal Business Name | HEREBA MENTAL HEALTH COUNSELING, LMHC, PC
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 124 NORTHERN LIGHTS DR STE 30
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-4119
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Country | US
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Telephone | 315-552-0201
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Fax |
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Provider Business Mailing Address
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Address Line | 115 GORLAND AVE
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City | SYRACUSE
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State | NY
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Zip | 13224-1615
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Country | US
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Telephone | 315-256-7985
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LESLIE SHAFFER HEREBA
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Credential | MS, LMHC
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Telephone | 315-552-0201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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