Provider Demographics
NPI:1376775817
Name:OKAZAKI, MARK H (LMSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:OKAZAKI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 W ONONDAGA ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1888
Mailing Address - Country:US
Mailing Address - Phone:315-478-0610
Mailing Address - Fax:315-478-2510
Practice Address - Street 1:375 W ONONDAGA ST
Practice Address - Street 2:SUITE 24
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1888
Practice Address - Country:US
Practice Address - Phone:315-478-0610
Practice Address - Fax:315-478-2510
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker