Individual
MARY IRENE BALCERAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 MADISON ST, SYRACUSE, NY 13210-2319
(315) 426-3985
Mailing address
50 HARPENDING AVE, DUNDEE, NY 14837-1150
(607) 678-0014
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
433624
NY
323P00000X
Psychiatric Residential Treatment Facility
433624
NY
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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