Provider Demographics
NPI:1003139783
Name:MENEGAUX, CONSTANCE BROOKE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:BROOKE
Last Name:MENEGAUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FOREST AVE.
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1298
Mailing Address - Country:US
Mailing Address - Phone:716-816-2445
Mailing Address - Fax:716-816-2537
Practice Address - Street 1:301 CAYUGA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1950
Practice Address - Country:US
Practice Address - Phone:716-819-3420
Practice Address - Fax:716-819-3430
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY064830-1104100000X, 1041C0700X
NY0841641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker