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General NPI Number Information
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NPI Number | 1780046193
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Entity Type | Individual
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Provider Name | DIANE PENNIE JONES LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 620 MADISON STREET
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City | SYRACUSE
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State | NY
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Zip | 13210
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Country | US
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Telephone | 316-426-4762
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Fax | 431-542-6476
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Provider Business Mailing Address
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Address Line | 620 MADISON STREET
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City | SYRACUSE
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State | NY
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Zip | 13210
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Country | US
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Telephone | 316-426-4762
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Fax | 431-542-6476
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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 | 067596
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 084588
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License Number State | NY
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