| Child & Fam Svc Otpt Mh Cl | |
|
635 James St Syracuse NY 13203-2226 | |
| (315) 671-2959 | |
| (315) 671-2977 |
| Full Name | Child & Fam Svc Otpt Mh Cl |
|---|---|
| Speciality | Counselor |
| Location | 635 James St, Syracuse, New York |
| Authorized Official Name and Position | Jeanne Maddox (BILLING MANAGER) |
| Authorized Official Contact | 3156712959 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Child & Fam Svc Otpt Mh Cl 635 James St Syracuse NY 13203-2226 Ph: (315) 671-2959 | Child & Fam Svc Otpt Mh Cl 635 James St Syracuse NY 13203-2226 Ph: (315) 671-2959 |
| NPI Number | 1336256213 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 06/25/2008 |
| Medicare PECOS PAC ID | 5799688719 |
|---|---|
| Medicare Enrollment ID | O20040128000748 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336256213 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Robert E Paganelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639283005 PECOS PAC ID: 2466467063 Enrollment ID: I20060221000424 |
| Provider Name | Md G Mohiuddin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437367448 PECOS PAC ID: 5890965099 Enrollment ID: I20110825000578 |
| Provider Name | Intikhab Ahmad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710008693 PECOS PAC ID: 9830360833 Enrollment ID: I20110923000255 |
| Provider Name | Kristen Diane Miguel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558511683 PECOS PAC ID: 8820254147 Enrollment ID: I20120731000467 |
| Provider Name | Anwarul Karim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033396734 PECOS PAC ID: 1951461805 Enrollment ID: I20121026000230 |
| Provider Name | Stephanie Ann Visconti |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336458736 PECOS PAC ID: 6901042894 Enrollment ID: I20130419000298 |
| Provider Name | Sarah D Bowers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689978520 PECOS PAC ID: 0244459873 Enrollment ID: I20140915000913 |
| Provider Name | Archana Kathpal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649306606 PECOS PAC ID: 6103138797 Enrollment ID: I20150710001003 |
| Provider Name | Tarun Kumar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144589201 PECOS PAC ID: 9032421581 Enrollment ID: I20150713000027 |
| Provider Name | Heather M Griffith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902160229 PECOS PAC ID: 4284930892 Enrollment ID: I20160308001932 |
| Provider Name | Gerald Matthew Myers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346688298 PECOS PAC ID: 5294027090 Enrollment ID: I20160715000428 |
| Provider Name | Susan Diann Gaskins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336476084 PECOS PAC ID: 2769774496 Enrollment ID: I20160715001737 |
| Provider Name | Frances A Mosconi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487858189 PECOS PAC ID: 9335427244 Enrollment ID: I20161027002249 |
| Provider Name | Katrin Ann Scheurer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275969669 PECOS PAC ID: 9133408719 Enrollment ID: I20161123000307 |
| Provider Name | Deborah Mccarthy Boland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356542401 PECOS PAC ID: 2062793540 Enrollment ID: I20161220002095 |
| Provider Name | Julie A Andrews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912142308 PECOS PAC ID: 2567748247 Enrollment ID: I20170412000141 |
| Provider Name | Heather Thompson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255584249 PECOS PAC ID: 3779869029 Enrollment ID: I20170426000987 |
| Provider Name | Katie Lyn Mcquaide |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568881373 PECOS PAC ID: 9739440900 Enrollment ID: I20180302002313 |
| Provider Name | Maria B Pineda-largoza |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689928202 PECOS PAC ID: 0840589164 Enrollment ID: I20191029002448 |
| Provider Name | Kristin R O'kane |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710369673 PECOS PAC ID: 1951728682 Enrollment ID: I20200826002843 |
| Provider Name | Priyanka Patil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053796045 PECOS PAC ID: 0143566935 Enrollment ID: I20200911000575 |
| Provider Name | Jenelle M Coit |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053706770 PECOS PAC ID: 4284045261 Enrollment ID: I20201123002617 |
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