=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447538277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD B FALSEY LCSW-R
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2011
-----------------------------------------------------
Last Update Date | 07/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7266 BUCKLEY RD
-----------------------------------------------------
City | N SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13212-2649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-458-0919
-----------------------------------------------------
Fax | 315-458-0954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 812 N SALINA ST
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13208-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-559-4711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R033135-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------