Provider Demographics
NPI:1184009805
Name:CONNECTED COUNSELING OF CNY
Entity type:Organization
Organization Name:CONNECTED COUNSELING OF CNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:REICHERT SCHIMPFF
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:315-391-8501
Mailing Address - Street 1:7232 MANLIUS CENTER RD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9539
Mailing Address - Country:US
Mailing Address - Phone:315-391-8501
Mailing Address - Fax:
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:SUITE 124
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-407-4235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000154261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)