=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285296129
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBEKKA CROFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2019
-----------------------------------------------------
Last Update Date | 07/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3532 JAMES ST STE 112
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13206-2722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-963-9413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 319 STEWARTS CORNERS RD
-----------------------------------------------------
City | PENNELLVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13132-3238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-643-1763
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------