Provider Demographics
NPI:1073643219
Name:SCOZZARO, CHRISTOPHER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:SCOZZARO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4184 SENECA ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3051
Mailing Address - Country:US
Mailing Address - Phone:716-675-2032
Mailing Address - Fax:
Practice Address - Street 1:4184 SENECA ST
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3051
Practice Address - Country:US
Practice Address - Phone:716-675-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045024-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01526443Medicaid
NY086141Medicare ID - Type Unspecified