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600 Oswego St Liverpool NY 13088-5178 | |
| (315) 658-6496 | |
| (315) 457-6000 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 600 Oswego St, Liverpool, New York |
| Authorized Official Name and Position | Rita Worlock (OWNER) |
| Authorized Official Contact | 3156586496 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
600 Oswego St Liverpool NY 13088-5178 Ph: (315) 760-4589 | 600 Oswego St Liverpool NY 13088-5178 Ph: (315) 658-6496 |
| NPI Number | 1255119830 |
|---|---|
| Provider Enumeration Date | 09/15/2023 |
| Last Update Date | 10/18/2024 |
| Certification Date | 10/18/2024 |
| Medicare PECOS PAC ID | 7416488549 |
|---|---|
| Medicare Enrollment ID | O20241001000981 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255119830 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Rita Worlock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992231427 PECOS PAC ID: 2668846171 Enrollment ID: I20230324000718 |
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