Provider Demographics
NPI:1699003574
Name:MILLS, CHERYL SUSAN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:SUSAN
Last Name:MILLS
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 1:1526 WALDEN AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4985
Mailing Address - Country:US
Mailing Address - Phone:716-895-6700
Mailing Address - Fax:716-332-4488
Practice Address - Street 1:1526 WALDEN AVENUE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4985
Practice Address - Country:US
Practice Address - Phone:716-895-6700
Practice Address - Fax:716-332-4488
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038817-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical