Provider Demographics
NPI:1669708269
Name:MISS, HELENE LAURE
Entity type:Individual
Prefix:
First Name:HELENE
Middle Name:LAURE
Last Name:MISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213
Mailing Address - Country:US
Mailing Address - Phone:716-884-0770
Mailing Address - Fax:716-884-0631
Practice Address - Street 1:951 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213
Practice Address - Country:US
Practice Address - Phone:716-884-0770
Practice Address - Fax:716-884-0631
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077968-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker