Provider Demographics
NPI:1811013105
Name:WIECZOREK, ALICIA MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MARIE
Last Name:WIECZOREK
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 1:3350 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214
Mailing Address - Country:US
Mailing Address - Phone:716-835-7807
Mailing Address - Fax:716-835-3963
Practice Address - Street 1:3350 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214
Practice Address - Country:US
Practice Address - Phone:716-835-7807
Practice Address - Fax:716-835-3963
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071855-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical