Provider Demographics
NPI:1780350074
Name:WESTERN NEW YORK LICENSED CLINICAL SOCIAL WORK SERVICES PLLC
Entity type:Organization
Organization Name:WESTERN NEW YORK LICENSED CLINICAL SOCIAL WORK SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZOUREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-628-5296
Mailing Address - Street 1:223 COTTONWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1608
Mailing Address - Country:US
Mailing Address - Phone:716-628-5296
Mailing Address - Fax:
Practice Address - Street 1:300 N FOREST RD.
Practice Address - Street 2:STE #S258
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1608
Practice Address - Country:US
Practice Address - Phone:716-628-5296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty