Provider Demographics
NPI:1336308238
Name:SYRACUSE INSTITUTE FOR HEALING RELATIONSHIPS
Entity Type:Organization
Organization Name:SYRACUSE INSTITUTE FOR HEALING RELATIONSHIPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR AND INSTRUCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HAAS-CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:315-409-3311
Mailing Address - Street 1:305 RIVERGLEN RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2815
Mailing Address - Country:US
Mailing Address - Phone:315-652-4338
Mailing Address - Fax:
Practice Address - Street 1:305 RIVERGLEN RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2815
Practice Address - Country:US
Practice Address - Phone:315-652-4338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty