Provider Demographics
NPI:1609383132
Name:MAHARDY, ERIN CERIDWEN (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:CERIDWEN
Last Name:MAHARDY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-2718
Mailing Address - Country:US
Mailing Address - Phone:716-828-7955
Mailing Address - Fax:
Practice Address - Street 1:120 ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-2718
Practice Address - Country:US
Practice Address - Phone:716-828-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101950104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker