Provider Demographics
NPI:1265582639
Name:GOTTLIEB-SASS, WENDY JANINE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:JANINE
Last Name:GOTTLIEB-SASS
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 1:103 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1532
Mailing Address - Country:US
Mailing Address - Phone:716-636-6907
Mailing Address - Fax:716-886-7398
Practice Address - Street 1:406 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1629
Practice Address - Country:US
Practice Address - Phone:716-886-7304
Practice Address - Fax:716-886-7398
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR030061-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health