Provider Demographics
NPI:1275279150
Name:CNY MUSIC THERAPY LLC
Entity Type:Organization
Organization Name:CNY MUSIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:FATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MT-BC, LCAT
Authorized Official - Phone:315-751-3096
Mailing Address - Street 1:111 CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3045
Mailing Address - Country:US
Mailing Address - Phone:315-751-3096
Mailing Address - Fax:
Practice Address - Street 1:111 CIRCLE RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-3045
Practice Address - Country:US
Practice Address - Phone:315-751-3096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty