Provider Demographics
NPI:1972117356
Name:ELEANYA, MARYPRISCA ETHEL (LMSW)
Entity type:Individual
Prefix:
First Name:MARYPRISCA
Middle Name:ETHEL
Last Name:ELEANYA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 E ONONDAGA ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2608
Mailing Address - Country:US
Mailing Address - Phone:908-759-6054
Mailing Address - Fax:
Practice Address - Street 1:262 E ONONDAGA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2608
Practice Address - Country:US
Practice Address - Phone:908-759-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109137-01101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor