Provider Demographics
NPI:1720043680
Name:OLEXENKO, SUE B (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:B
Last Name:OLEXENKO
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-1910
Mailing Address - Country:US
Mailing Address - Phone:716-874-4500
Mailing Address - Fax:716-874-8145
Practice Address - Street 1:2128 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-1910
Practice Address - Country:US
Practice Address - Phone:716-874-4500
Practice Address - Fax:716-874-8145
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0476911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000526001001OtherFAMILY HEALTH PLUS
050730000006OtherFIDELIS FAMILY HEALTH PLS
000526001001OtherCHILD HEALTH PLUS
000526001001OtherCOMM CARE MEDICAID MGD C
000526001001OtherHMO 100
00011249905OtherASO
000526001001OtherHEALTHLY NY
000526001001OtherBCBS WNY
000526001001OtherCOMMUNITY BLUE STD HMO
000526001001OtherSECURE BLUE POS
000526001001OtherCB ADVANTAGE HMO
000526001001OtherSECURE BLUE PPO
000526001001OtherSECURE BLUE INDEMNITY
050730000006OtherFIDELIS CHILD HEALTH PLUS
000526001001OtherCB LABOR HEALTH HMO
000526001001OtherSENIOR BLUE HMO
050730000006OtherFIDELIS MEDICAID
NY01465154Medicaid
050730000006OtherFIDELIS CHILD HEALTH PLUS