Provider Demographics
NPI:1801098587
Name:ENDRES, FRANK BONIFACE (LCSW-R)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:BONIFACE
Last Name:ENDRES
Suffix:
Gender:M
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 1:4615 HEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6149
Mailing Address - Country:US
Mailing Address - Phone:716-631-8091
Mailing Address - Fax:
Practice Address - Street 1:4615 HEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6149
Practice Address - Country:US
Practice Address - Phone:716-631-8091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO13350-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53955Medicare UPIN
NYCC1983Medicare ID - Type Unspecified