Individual provider Active NPI

Cynthia Joan Ackles, LCSW

  • Clinical Social Worker
  • Syracuse, NY
National Provider Identifier
1972612893
Registry record updated Jan 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
071054-1 Issued in NY
Practice address
3300 James St
Syracuse, NY 13206
Phone
(315) 422-0300
NPI assigned
Aug 30, 2006
Last updated
Jan 19, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 071054-1 NY Primary

Addresses

Primary practice location

3300 James St
Syracuse, NY 13206

Mailing address

3300 James St
Syracuse, NY 13206-2387
Phone (315) 422-0300

Other identifiers 1

IdentifierTypeStateIssuer
01649605MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071054-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Psychological Healthcare, PLLC CurrentSince Dec 1, 2015 Accepting new patients
Buffalo Centre for the Treatment of Eating Disorders Mental Health PastSince Jan 26, 2022 Accepting new patients

Locations

8289 Loop Rd
Baldwinsville, NY 13027
Phone (315) 452-0300

3300 James St
Ste 100
Syracuse, NY 13206
Phone (315) 671-2202

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1972612893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132062387",
            "telephone_number": "315-422-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13206",
            "telephone_number": "315-422-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACKLES",
        "first_name": "CYNTHIA",
        "middle_name": "JOAN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "071054-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01649605",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.