1912193186 NPI number — MISS RENEE L PIERCE LCSW

Table of content: MISS RENEE L PIERCE LCSW (NPI 1912193186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912193186 NPI number — MISS RENEE L PIERCE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIERCE
Provider First Name:
RENEE
Provider Middle Name:
L
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912193186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 PROSPECT AVE
Provider Second Line Business Mailing Address:
BUSINESS OFFICE
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-448-5375
Provider Business Mailing Address Fax Number:
315-448-6506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
742 JAMES ST
Provider Second Line Business Practice Location Address:
OUTPATIENT MENTAL HEALTH
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13203-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-703-2700
Provider Business Practice Location Address Fax Number:
315-703-2730
Provider Enumeration Date:
09/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  73 079673 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)