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General NPI Number Information
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NPI Number | 1780963280
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Entity Type | Individual
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Provider Name | EMILY CORNELL
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Gender | Female
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Dates
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Enumeration Date | 08/15/2011
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 113 CHURCH ST
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-2370
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Country | US
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Telephone | 315-415-0308
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Fax |
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Provider Business Mailing Address
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Address Line | 33 OAK DR
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City | UNION SPRINGS
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State | NY
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Zip | 13160-9713
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Country | US
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Telephone | 607-382-3726
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 005686
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License Number State | NY
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