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1 Adler Dr Ste 5 East Syracuse NY 13057-1223 | |
| (315) 415-0308 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1 Adler Dr Ste 5, East Syracuse, New York |
| Authorized Official Name and Position | Katherine Sargent Hyatt (OWNER) |
| Authorized Official Contact | 3154150308 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
113 Church St N Syracuse NY 13212-2370 Ph: (315) 415-0308 | 1 Adler Dr Ste 5 East Syracuse NY 13057-1223 Ph: (315) 415-0308 |
| NPI Number | 1750845749 |
|---|---|
| Provider Enumeration Date | 01/24/2019 |
| Last Update Date | 10/25/2024 |
| Certification Date | 10/25/2024 |
| Medicare PECOS PAC ID | 4082147962 |
|---|---|
| Medicare Enrollment ID | O20241030003564 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750845749 | NPI | - | NPPES |
| 07661136 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Katherine Sargent Hyatt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609275528 PECOS PAC ID: 7618400599 Enrollment ID: I20241030003674 |
| Provider Name | Amanda Cunningham |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477118636 PECOS PAC ID: 7214461003 Enrollment ID: I20241115002893 |
| Provider Name | Lori M Rose |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477250082 PECOS PAC ID: 3173058666 Enrollment ID: I20241120002942 |
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