Provider Demographics
NPI:1205622669
Name:PETKO, CHARLES JOSEPH JR (LMSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:PETKO
Suffix:JR
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 COVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2811
Mailing Address - Country:US
Mailing Address - Phone:716-935-9783
Mailing Address - Fax:
Practice Address - Street 1:211 COVINGTON DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2811
Practice Address - Country:US
Practice Address - Phone:716-935-9783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker