MEDICARE: MS. CYNTHIA LEIGH BAHN 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
1	1041C0700X	Clinical Social Worker	PRO16192	NY

General Provider Information

NPI Number	:	1861462160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA LEIGH BAHN M.S.W.

Provider Business Mailing Address
First Line	:	109 S WARREN ST
Second Line	:	SUITE 912
City	:	SYRACUSE
State	:	NY
Zip	:	13202-1798
Country	:	US
Telephone Number	:	315-445-5554
Fax Number	:	315-446-1562

Provider Business Practice Location Address
First Line	:	7000 E GENESEE ST
Second Line	:	BUILDING C- UPPER
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1131
Country	:	US
Telephone Number	:	315-445-5554
Fax Number	:	315-446-1562

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2007

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