Provider Demographics
NPI:1710971361
Name:CREIGHTON, CAROL J (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:CREIGHTON
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 1:1837 HERTEL AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3006
Mailing Address - Country:US
Mailing Address - Phone:716-834-0990
Mailing Address - Fax:716-834-5116
Practice Address - Street 1:1837 HERTEL AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-3006
Practice Address - Country:US
Practice Address - Phone:716-834-0990
Practice Address - Fax:716-834-5116
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR011345-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000500044001OtherHEALTH NOW
NY000500044001OtherHEALTH NOW