Provider Demographics
NPI:1467963132
Name:PRIVETT, DAVID THOMAS (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:THOMAS
Last Name:PRIVETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1712
Mailing Address - Country:US
Mailing Address - Phone:716-655-4574
Mailing Address - Fax:
Practice Address - Street 1:1010 EAST AND WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3602
Practice Address - Country:US
Practice Address - Phone:716-677-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0732251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical