Provider Demographics
NPI:1639262546
Name:TRYTEK, DARLENE MARIE (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:MARIE
Last Name:TRYTEK
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SLOSSON LANE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456
Mailing Address - Country:US
Mailing Address - Phone:315-781-7800
Mailing Address - Fax:
Practice Address - Street 1:59 SLOSSON LANE
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456
Practice Address - Country:US
Practice Address - Phone:315-781-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05260911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02398790Medicaid
110536FKOtherPREFERRED CARE
110536FKOtherPREFERRED CARE
DD1693Medicare ID - Type Unspecified