Provider Demographics
NPI:1114794203
Name:PACHECO, CONNIE (LMSW)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2105
Mailing Address - Country:US
Mailing Address - Phone:716-912-2130
Mailing Address - Fax:
Practice Address - Street 1:327 PARKER AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2105
Practice Address - Country:US
Practice Address - Phone:716-912-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2596406104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker