Provider Demographics
NPI:1194380295
Name:REEDY, ELIZABETH A (LMSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:REEDY
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 1:355 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1892
Mailing Address - Country:US
Mailing Address - Phone:716-982-5214
Mailing Address - Fax:
Practice Address - Street 1:1397 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4029
Practice Address - Country:US
Practice Address - Phone:716-982-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0915321041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool