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NPI Code Detail

MEDICARE: CHARLES I CRAIGMILE LCSW

MEDICARE: CHARLES I CRAIGMILE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerR039542-1NY

General Provider Information

NPI Number : 1063426427
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES I CRAIGMILE LCSW
Provider Business Mailing Address
First Line : 119 COUNTY ROUTE 6
Second Line :
City : PHOENIX
State : NY
Zip : 13135-2119
Country : US
Telephone Number : 315-695-6900
Fax Number : 315-695-6900
Provider Business Practice Location Address
First Line : 2100 E GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-2249
Country : US
Telephone Number : 315-695-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 07/08/2007

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Directions to “ CHARLES I CRAIGMILE LCSW” Practice Location

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