=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932682069
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUMANITY COUNSELING SERVICES LCSW PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2018
-----------------------------------------------------
Last Update Date | 01/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5900 N BURDICK ST STE 213
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-9465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-447-9670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5900 N BURDICK ST STE 213
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-9465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-447-9670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LCSW
-----------------------------------------------------
Name | PATRICK MCFALLS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 315-447-9670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------