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General NPI Number Information
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NPI Number | 1497119192
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Entity Type | Organization
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Legal Business Name | SYRACUSE FAMILY COUNSELING LCSW P.C.
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 2507 JAMES ST STE 203
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City | SYRACUSE
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State | NY
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Zip | 13206-2895
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Country | US
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Telephone | 315-748-8735
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Fax |
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Provider Business Mailing Address
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Address Line | 2507 JAMES ST STE 203
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City | SYRACUSE
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State | NY
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Zip | 13206-2895
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Country | US
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Telephone | 315-748-8735
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SHANE KEITH BROWN
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Credential | LCSW
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Telephone | 315-447-3670
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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 | 080775
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License Number State | NY
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