Provider Demographics
NPI:1902847460
Name:SMITH, SARAH A (LCSW-R)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:212 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1916
Mailing Address - Country:US
Mailing Address - Phone:716-885-6886
Mailing Address - Fax:
Practice Address - Street 1:1412 SWEET HOME RD
Practice Address - Street 2:SUITE 1
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2795
Practice Address - Country:US
Practice Address - Phone:716-430-2524
Practice Address - Fax:716-689-0593
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0526861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300025377Medicare UPIN