MEDICARE: MS. ELIZABETH A PARRIS MSW

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
1	104100000X	Social Worker	9495	SC

General Provider Information

NPI Number	:	1710206008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH A PARRIS MSW

Provider Business Mailing Address
First Line	:	11691B CARDINAL AVE
Second Line	:
City	:	FORT DRUM
State	:	NY
Zip	:	13603-3123
Country	:	US
Telephone Number	:	315-782-7445
Fax Number	:	315-779-1184

Provider Business Practice Location Address
First Line	:	218 STONE ST FL 2
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-3211
Country	:	US
Telephone Number	:	315-782-7445
Fax Number	:	315-779-1184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	05/26/2010

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