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General NPI Number Information
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NPI Number | 1689947699
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Entity Type | Individual
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Provider Name | PHYLLIS IRENE PERRONE LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 7266 BUCKLEY RD
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-2649
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Country | US
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Telephone | 315-458-0919
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Fax | 315-458-0954
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Provider Business Mailing Address
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Address Line | 203 ONTARIO PL
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City | LIVERPOOL
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State | NY
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Zip | 13088-5642
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Country | US
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Telephone | 315-415-4717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 062537-01
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License Number State | NY
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