Provider Demographics
NPI:1073645016
Name:HUNGERFORD, LAREINE F (LCSW-R)
Entity Type:Individual
Prefix:
First Name:LAREINE
Middle Name:F
Last Name:HUNGERFORD
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:LAREINE
Other - Middle Name:F
Other - Last Name:CLOPPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:415 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1542
Mailing Address - Country:US
Mailing Address - Phone:716-881-2296
Mailing Address - Fax:716-886-0701
Practice Address - Street 1:415 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1542
Practice Address - Country:US
Practice Address - Phone:716-881-2296
Practice Address - Fax:716-886-0701
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR024662-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU01301457OtherCIGNA
NY6207985OtherINDEPENDENT HEALTH
NY174489OtherCOMPSYCH
NY00020249201OtherUNIVERA EXELLUS
NY272891OtherPHCS (PIN)
NY000504604003OtherBCBS PAYEE ID NO.
NY174489OtherCOMPSYCH
NY6207985OtherINDEPENDENT HEALTH