Most Relevant Information
Provider Data
| NPI Number: | 1003587643 |
| Provider Name: | MARYJANE QUENNEVILLE |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 085429 |
Most Important Dates
| Enumeration Date: | 09/23/2021 |
| Last Updated: | 03/13/2023 |
Provider Practice Location
124 NORTHERN LIGHTS DR STE 20
SYRACUSE
NY
132124119
Practice Location Phone/Fax
| Phone: | 3153261008 |
| Fax: |
Provider Mailing Location
124 NORTHERN LIGHTS DR STE 20
SYRACUSE
NY
132124119
Provider Mailing Phone/Fax
| Phone: | 3153261008 |
| Fax: |