Provider Demographics
NPI:1407949829
Name:SLAUGHTER, MARGO ANN (MSW,ACSW,DCSW)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:ANN
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:MSW,ACSW,DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 STRAIGHT RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-9774
Mailing Address - Country:US
Mailing Address - Phone:716-679-1962
Mailing Address - Fax:
Practice Address - Street 1:3160 STRAIGHT RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-9774
Practice Address - Country:US
Practice Address - Phone:716-679-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR017298-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000508573001OtherBLUE CROSS/BLUE SHIELD
NY000020320101OtherUNIVERA
NY6207967OtherINDEPENDENT HEALTH
NY00020329101OtherUNIVERA
NY0035285002OtherVALUE OPTIONS
NY6207967OtherINDEPENDENT HEALTH