Provider Demographics
NPI:1043430135
Name:JAFARI, FATEMEH (CSWR LCSW)
Entity Type:Individual
Prefix:MS
First Name:FATEMEH
Middle Name:
Last Name:JAFARI
Suffix:
Gender:F
Credentials:CSWR LCSW
Other - Prefix:MS
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:JAFARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSWR LCSW
Mailing Address - Street 1:297 SHETLAND DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-565-1288
Mailing Address - Fax:716-832-7400
Practice Address - Street 1:4232 RIDGE LEA RD
Practice Address - Street 2:SUITE 28
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-565-1288
Practice Address - Fax:716-832-7400
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0499551104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD7136Medicare ID - Type Unspecified