Provider Demographics
NPI:1629002274
Name:PAULEY, TAMMY (LCSW-R)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:PAULEY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 N BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1933
Mailing Address - Country:US
Mailing Address - Phone:716-592-4286
Mailing Address - Fax:716-592-4287
Practice Address - Street 1:584 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1437
Practice Address - Country:US
Practice Address - Phone:716-592-4286
Practice Address - Fax:716-592-4287
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0735801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03128732Medicaid
NY03128732Medicaid