Provider Demographics
NPI:1568539351
Name:LICURSE, WILLIAM J (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:LICURSE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3300 JAMES ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2387
Mailing Address - Country:US
Mailing Address - Phone:315-422-0300
Mailing Address - Fax:315-479-8455
Practice Address - Street 1:890 7TH NORTH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6558
Practice Address - Country:US
Practice Address - Phone:315-200-1056
Practice Address - Fax:315-452-2455
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0182351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC9443Medicare ID - Type Unspecified