Basic Information
| Provider Information | |||||||||
| NPI: | 1366480204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIERAK | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 NOYES ST | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135023854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157384440 | ||||||||
| FaxNumber: | 3157384410 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 NOYES ST | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135023854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157384440 | ||||||||
| FaxNumber: | 3157384410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 09/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 078235-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 00474180 | 05 | NY | MEDICAID |