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General NPI Number Information
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NPI Number | 1326593849
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Entity Type | Organization
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Legal Business Name | SYRACUSE PSYCHOLOGICAL SERVICES PC
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 960 SALT SPRINGS RD
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City | SYRACUSE
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State | NY
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Zip | 13224-1639
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Country | US
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Telephone | 315-446-6250
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Fax | 315-445-2667
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Provider Business Mailing Address
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Address Line | 960 SALT SPRINGS RD
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City | SYRACUSE
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State | NY
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Zip | 13224-1639
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Country | US
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Telephone | 315-446-6250
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Fax | 315-445-2667
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. PATRICK CASEY
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Credential | PH.D.
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Telephone | 315-446-6250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 017990
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License Number State | NY
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