Provider Demographics
NPI:1609475276
Name:HLADCZUK, ELIZABETH AMBER (LMSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AMBER
Last Name:HLADCZUK
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 1:93 KELVIN DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2224
Mailing Address - Country:US
Mailing Address - Phone:716-645-2055
Mailing Address - Fax:
Practice Address - Street 1:388 EVANS ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5626
Practice Address - Country:US
Practice Address - Phone:716-580-7647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095024-02104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY095024OtherSTATE EDUCATION DEPARTMENT, OFFICE OF PROFESSIONALS, DIVISION OF PROFESSIONAL LI