Provider Demographics
NPI:1912097445
Name:SALAZAR, CHANDRA L (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:L
Last Name:SALAZAR
Suffix:
Gender:F
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:LACKAWANNA COUNSELING/DAASP
Mailing Address - Street 2:2600 SOUTH PARK AVENUE
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218
Mailing Address - Country:US
Mailing Address - Phone:716-822-2117
Mailing Address - Fax:716-822-8165
Practice Address - Street 1:LACKAWANNA COUNSELING/DAASP
Practice Address - Street 2:2600 SOUTH PARK AVENUE
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218
Practice Address - Country:US
Practice Address - Phone:716-822-2117
Practice Address - Fax:716-822-8165
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073504104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY073504OtherLMSW