Organization
SIMPLE SERENITY THERAPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE DEFURIO LCSW-R (OWNER/THERAPIST)
(315) 806-3008
Entity
Organization
Contact information
Practice address
125 TEJAH AVE, SYRACUSE, NY 13210
(315) 313-4733
Mailing address
125 TEJAH AVE, SYRACUSE, NY 13210
(315) 806-3008
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04125137
—
NY
Enumeration date
07/19/2021
Last updated
07/19/2021
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