Provider Demographics
NPI:1083928972
Name:CNY MARRIAGE & FAMILY THERAPY PLACE
Entity Type:Organization
Organization Name:CNY MARRIAGE & FAMILY THERAPY PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAMM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:315-299-6975
Mailing Address - Street 1:792 N MAIN ST
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1644
Mailing Address - Country:US
Mailing Address - Phone:315-299-6975
Mailing Address - Fax:
Practice Address - Street 1:792 N MAIN ST
Practice Address - Street 2:SUITE 200E
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1644
Practice Address - Country:US
Practice Address - Phone:315-299-6975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000246106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty