Provider Demographics
NPI:1134232614
Name:DEMYAN, PATRICIA (MSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DEMYAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2249
Mailing Address - Country:US
Mailing Address - Phone:315-475-6337
Mailing Address - Fax:315-443-4146
Practice Address - Street 1:2100 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2249
Practice Address - Country:US
Practice Address - Phone:315-475-6337
Practice Address - Fax:315-443-4146
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR020692-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health