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General NPI Number Information
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NPI Number | 1811049265
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Entity Type | Organization
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Legal Business Name | DA MANCUSO COUNSELING
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1402 GENESEE ST
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City | UTICA
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State | NY
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Zip | 13502-4727
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Country | US
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Telephone | 315-735-8913
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8307
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City | UTICA
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State | NY
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Zip | 13505-8307
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Country | US
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Telephone | 315-735-8913
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID A MANCUSO
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Credential | LCSW
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Telephone | 315-735-8913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | NY
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