Provider Demographics
NPI:1811002405
Name:BOGDAN-FYLES, JOANNA PAULA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:PAULA
Last Name:BOGDAN-FYLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E GENESEE ST
Mailing Address - Street 2:SUITE 228
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3130
Mailing Address - Country:US
Mailing Address - Phone:315-234-0213
Mailing Address - Fax:315-234-0214
Practice Address - Street 1:600 E GENESEE ST
Practice Address - Street 2:SUITE 228
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3130
Practice Address - Country:US
Practice Address - Phone:315-234-0213
Practice Address - Fax:315-234-0214
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034387-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical