Provider Demographics
NPI:1982094926
Name:KING, ANNETTE COLLEEN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:COLLEEN
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ARSENAL DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2801
Mailing Address - Country:US
Mailing Address - Phone:315-415-3116
Mailing Address - Fax:
Practice Address - Street 1:731 JAMES ST
Practice Address - Street 2:SUITE 223
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2039
Practice Address - Country:US
Practice Address - Phone:315-708-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053890-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical