Individual provider · Type 1 NPI

Raegan Distasio

Mental Health Counselor · Syracuse, NY

NPI number 1851143473 Active

Practice location

1045 James St Ste 100
Syracuse, NY 13203-2758

Call (315) 472-4471 Map

Mailing address

501 Thayer Rd
Fairport, NY 14450-9514

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1851143473

Raegan Distasio's National Provider Identifier is 1851143473, issued on Apr 5, 2024. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Syracuse, NY. The record was last updated on Apr 5, 2024.