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General NPI Number Information
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NPI Number | 1316343437
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Entity Type | Organization
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Legal Business Name | ANNETTE COLLEEN KING
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 731 JAMES ST
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City | SYRACUSE
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State | NY
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Zip | 13203-2026
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Country | US
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Telephone | 315-708-9040
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Fax |
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Provider Business Mailing Address
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Address Line | 126 ARSENAL DR
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City | SYRACUSE
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State | NY
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Zip | 13205-2801
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Country | US
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Telephone | 315-415-3116
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANNETTE COLLEEN KING
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Credential | LCSW-R
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Telephone | 315-415-3116
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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 | 73053890
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License Number State | NY
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