Provider Demographics
NPI:1790847259
Name:GRIESMANN, CAROL ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ELIZABETH
Last Name:GRIESMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:ELIZABETH
Other - Last Name:ELVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6 TILLINGHAST PL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3409
Mailing Address - Country:US
Mailing Address - Phone:716-845-8022
Mailing Address - Fax:
Practice Address - Street 1:ELM AND CARLTON ST
Practice Address - Street 2:ROSWELL PARK CANCER INSTITUTE
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216
Practice Address - Country:US
Practice Address - Phone:716-845-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0385101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR038510OtherLICENSE