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NPI Code Detail

MEDICARE: PATRICIA DEMYAN M.S.W.

MEDICARE: PATRICIA DEMYAN M.S.W.
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
1101YM0800XMental Health CounselorPR020692-1NY

General Provider Information

NPI Number : 1134232614
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA DEMYAN M.S.W.
Provider Business Mailing Address
First Line : 2100 E GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-2249
Country : US
Telephone Number : 315-475-6337
Fax Number : 315-443-4146
Provider Business Practice Location Address
First Line : 2100 E GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-2249
Country : US
Telephone Number : 315-475-6337
Fax Number : 315-443-4146
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2006
Last Update Date : 07/08/2007

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