| Western New York Licensed Clinical Social Work Services, Pllc | |
|
300 N. Forest Rd. Ste #s256 Williamsville NY 14221-5056 | |
| (716) 628-5296 | |
| Not Available |
| Full Name | Western New York Licensed Clinical Social Work Services, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 300 N. Forest Rd., Williamsville, New York |
| Authorized Official Name and Position | Shirley B. Mazourek (OWNER/FOUNDER) |
| Authorized Official Contact | 7166285296 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Western New York Licensed Clinical Social Work Services, Pllc 223 Cottonwood Drive Williamsville NY 14221-1608 Ph: (716) 628-5296 | Western New York Licensed Clinical Social Work Services, Pllc 300 N. Forest Rd. Ste #s256 Williamsville NY 14221-5056 Ph: (716) 628-5296 |
| NPI Number | 1316648710 |
|---|---|
| Provider Enumeration Date | 03/13/2023 |
| Last Update Date | 03/13/2023 |
| Certification Date | 03/13/2023 |
| Medicare PECOS PAC ID | 2365807542 |
|---|---|
| Medicare Enrollment ID | O20230421001079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316648710 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Shirley B Mazourek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760545834 PECOS PAC ID: 6103908140 Enrollment ID: I20080129000583 |
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