Individual
ALICE CHANTHASENSAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1045 JAMES ST, SYRACUSE, NY 13203-2730
(315) 472-4471
Mailing address
1045 JAMES ST, SYRACUSE, NY 13203-2730
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
001545-1
NY
Other
Enumeration date
01/08/2019
Last updated
03/04/2020
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