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General NPI Number Information
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NPI Number | 1275811291
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Entity Type | Organization
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Legal Business Name | DEWITT COUNSELING ASSOCIATES, LCSW, PC
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 07/25/2011
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Provider Practice Location Address
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Address Line | 890 E BRIGHTON AVE
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City | SYRACUSE
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State | NY
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Zip | 13205-2538
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Country | US
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Telephone | 315-472-7885
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Fax | 315-472-2513
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Provider Business Mailing Address
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Address Line | 890 E BRIGHTON AVE
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City | SYRACUSE
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State | NY
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Zip | 13205-2538
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Country | US
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Telephone | 315-472-7885
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Fax | 315-472-2513
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Authorized Official
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Title or Position | OWNER
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Name | DONALD T GARDINER
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Credential | LCSWR
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Telephone | 315-472-7885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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