Provider Demographics
NPI:1346708831
Name:PEARSON, PARIS L (LCSW)
Entity Type:Individual
Prefix:
First Name:PARIS
Middle Name:L
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PARIS
Other - Middle Name:
Other - Last Name:VANARSDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1657 SAINT JANE AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5130
Mailing Address - Country:US
Mailing Address - Phone:315-292-4123
Mailing Address - Fax:
Practice Address - Street 1:143 W DOMINICK ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5857
Practice Address - Country:US
Practice Address - Phone:315-866-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087259-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical