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General NPI Number Information
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NPI Number | 1790972107
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Entity Type | Organization
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Legal Business Name | JOANNA BOGDAN-FYLES, LCSW, PLLC
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Dates
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Enumeration Date | 09/29/2007
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Last Update Date | 09/29/2007
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Provider Practice Location Address
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Address Line | 600 E GENESEE ST SUITE 228
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City | SYRACUSE
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State | NY
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Zip | 13202-3130
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Country | US
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Telephone | 315-234-0213
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Fax | 315-234-0214
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Provider Business Mailing Address
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Address Line | 600 E GENESEE ST SUITE 228
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City | SYRACUSE
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State | NY
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Zip | 13202-3130
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Country | US
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Telephone | 315-234-0213
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Fax | 315-234-0214
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Authorized Official
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Title or Position | OWNER
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Name | MS. JOANNA PAULA BOGDAN-FYLES
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Credential | LCSW
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Telephone | 315-234-0213
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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 | R034387-1
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License Number State | NY
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