Provider Demographics
NPI:1790147403
Name:AMMERMAN, DENISE JOREEN (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:JOREEN
Last Name:AMMERMAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MISS
Other - First Name:DENISE
Other - Middle Name:JOREEN
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138 LISTON STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1323
Mailing Address - Country:US
Mailing Address - Phone:716-875-2526
Mailing Address - Fax:716-242-0082
Practice Address - Street 1:138 LISTON STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1323
Practice Address - Country:US
Practice Address - Phone:716-875-2526
Practice Address - Fax:716-242-0082
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-0808211041C0700X
NYR73-0808211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14-1663311OtherSTATE TAX ID #