Provider Demographics
NPI:1427195965
Name:GOSTOMSKI, BEVERLY J (LCSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:GOSTOMSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5366 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1122
Mailing Address - Country:US
Mailing Address - Phone:716-741-9004
Mailing Address - Fax:
Practice Address - Street 1:153 W UTICA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2017
Practice Address - Country:US
Practice Address - Phone:716-884-7569
Practice Address - Fax:716-884-4087
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075620-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical