Provider Demographics
NPI:1346563996
Name:COFFTA, STEPHANIE ANN (LCSWR)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:COFFTA
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SYLVAN PKWY
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-1513
Mailing Address - Country:US
Mailing Address - Phone:716-238-5808
Mailing Address - Fax:716-626-4271
Practice Address - Street 1:21 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6501
Practice Address - Country:US
Practice Address - Phone:716-565-2140
Practice Address - Fax:716-626-4271
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063026-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical