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General NPI Number Information
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NPI Number | 1447767025
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Entity Type | Organization
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Legal Business Name | REALITY AWARENESS OUTREACH INC
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 12/24/2021
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Provider Practice Location Address
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Address Line | 117 S COLLINGWOOD AVE
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City | SYRACUSE
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State | NY
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Zip | 13206
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Country | US
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Telephone | 315-567-9934
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Fax |
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Provider Business Mailing Address
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Address Line | 203 LUDDINGTON ST APT 2
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City | SYRACUSE
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State | NY
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Zip | 13206-3120
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Country | US
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Telephone | 315-567-9934
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ISAAC RIVERS JR.
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Credential |
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Telephone | 315-567-9934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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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 | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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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 | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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