Provider Demographics
NPI:1861504128
Name:CREAMER, JANICE CATHERINE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:CATHERINE
Last Name:CREAMER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1120
Mailing Address - Country:US
Mailing Address - Phone:315-539-8451
Mailing Address - Fax:
Practice Address - Street 1:3019 COUNTY COMPLEX DR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9505
Practice Address - Country:US
Practice Address - Phone:585-396-4363
Practice Address - Fax:585-396-4993
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0513221041C0700X
NY001861133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYEMOtherEXCELLUS
NY07300051322Medicaid
NY103283EUOtherPREFERRED CARE
NY3109089OtherVALUE OPTIONS
NYEMOtherEXCELLUS
NYDD2339Medicare ID - Type UnspecifiedMNT MEDICARE
NYDD2338Medicare ID - Type UnspecifiedOTHER MEDICARE
NY07300051322Medicaid