Provider Demographics
NPI:1033269758
Name:SPARACINO, JOLENE T (MLSW)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:T
Last Name:SPARACINO
Suffix:
Gender:F
Credentials:MLSW
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:
Other - Last Name:HEFFRON SPARACINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1001 ELEVENTH STREET
Mailing Address - Street 2:ROOM 2021 TROTT ACCESS CENTER
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-278-1940
Mailing Address - Fax:716-278-1943
Practice Address - Street 1:3435 HARLEM RD STE 3
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2021
Practice Address - Country:US
Practice Address - Phone:716-785-2903
Practice Address - Fax:162-714-5857
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
073143104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker