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MARYJANE QUENNEVILLE
NPI 1003587643
Social Worker - Clinical in Syracuse, NY

Active since September 23, 2021PECOS Enrolled
124 NORTHERN LIGHTS DR STE 20, SYRACUSE, NY 13212(315) 326-1008 Get Directions Write a Review

NPPES record last updated: March 13, 2023. Verified against the NPPES registry weekly; last sync: October 11, 2026.

Record update history: Mar 13, 2023, Feb 15, 2023, Sep 23, 2021 (3 updates tracked since 2021).

About Maryjane Quenneville NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARYJANE QUENNEVILLE (NPI 1003587643) is an individual clinical provider in Syracuse, New York, licensed in New York (085429) and active in the NPI registry since September 2021. She is enrolled in Medicare PECOS and maintains a secondary practice location in Brewerton.

NPPES Registry Identity

NPI1003587643
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameMARYJANE QUENNEVILLE
Location Address124 NORTHERN LIGHTS DR STE 20Syracuse, NY 13212-4119
Mailing Address124 Northern Lights Dr Ste 20Syracuse, NY 13212-4119 · (315) 326-1008
Phone(315) 326-1008
Sole ProprietorYes
Enumeration DateSeptember 23, 2021
Last NPPES UpdateMarch 13, 20233 updates tracked since enumeration
NPPES CertifiedMarch 13, 2023
✔ NPI 1003587643 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in NY · 085429
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
124 NORTHERN LIGHTS DR STE 20, Syracuse, NY 13212
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Secondary Practice Location 1

Location 19430 Birch Tree RdBrewerton, NY 13029-9407 · Phone (315) 729-3701

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Maryjane Quenneville is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 13212 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $54.87 – $166.88
Typical copayment $0.00 (range $13.71 – $41.72)
Most-billed visit code NA
Established Patient
$68.57 typical visit price
range $17.54 – $136.14
Typical copayment $17.14 (range $4.38 – $34.03)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDREA RYAN MOJICA LMHC
Counselor (Mental Health)
124 NORTHERN LIGHTS DR STE 20
SYRACUSE, NY 13212
Onondaga County (315) 558-7374

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Maryjane Quenneville's NPI number?

The NPI number for Maryjane Quenneville is 1003587643. It was assigned to this individual provider in the NPPES registry on September 23, 2021.

Where is Maryjane Quenneville located?

Maryjane Quenneville practices at 124 Northern Lights Dr Ste 20, Syracuse, NY 13212. The listed phone number is (315) 326-1008.

What is Maryjane Quenneville's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Maryjane Quenneville enrolled in Medicare?

Yes. Maryjane Quenneville is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Maryjane Quenneville was last updated on March 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.