Provider Demographics
NPI:1740378751
Name:FANARA, CHARMAINE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:ANN
Last Name:FANARA
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 1:59 ALYS DR E
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1402
Mailing Address - Country:US
Mailing Address - Phone:716-391-7356
Mailing Address - Fax:716-393-3430
Practice Address - Street 1:59 ALYS DR E
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1402
Practice Address - Country:US
Practice Address - Phone:716-783-0407
Practice Address - Fax:716-393-3430
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071265-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00071265-1Medicaid
NY00071265-1Medicaid