Provider Demographics
NPI:1477577377
Name:MINEO, SANDRA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:J
Last Name:MINEO
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 1:5067 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1435
Mailing Address - Country:US
Mailing Address - Phone:716-741-4250
Mailing Address - Fax:716-741-4250
Practice Address - Street 1:5067 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1435
Practice Address - Country:US
Practice Address - Phone:716-741-4250
Practice Address - Fax:716-741-4250
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR0196521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY107257OtherMHN
NY0014769OtherVALUEOPTIONS
NY107257OtherMHN