Provider Demographics
NPI:1245243575
Name:OSTERSTROM, STEVEN B (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:B
Last Name:OSTERSTROM
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3176 ABBOTT RD
Mailing Address - Street 2:BUILDING A, SUITE 500,
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1069
Mailing Address - Country:US
Mailing Address - Phone:716-822-2117
Mailing Address - Fax:716-822-8165
Practice Address - Street 1:3176 ABBOTT RD
Practice Address - Street 2:BUILDING A, SUITE 500,
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1069
Practice Address - Country:US
Practice Address - Phone:716-822-2117
Practice Address - Fax:716-822-8165
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070801-1104100000X
NYR070801-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070801-1OtherLCSW
NYQ11183Medicare UPIN
NY070801-1OtherLCSW