Healthcare Provider Details

I. General information

NPI: 1114957065
Provider Name (Legal Business Name): ELIZABETH GEARY LSCW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 SWEET HOME RD
AMHERST NY
14226-1018
US

IV. Provider business mailing address

1185 SWEET HOME RD ATTN: CREDENTIALING
AMHERST NY
14226-1018
US

V. Phone/Fax

Practice location:
  • Phone: 716-689-0040
  • Fax: 716-568-2416
Mailing address:
  • Phone: 716-568-2335
  • Fax: 716-568-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number034604
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier040426031282
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerFIDELIS
# 2
Identifier7408536
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerGHI
# 3
Identifier00026902001
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerUNIVERA
# 4
Identifier000523054001
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBLUE CROSS & BLUE SHIELD
# 5
Identifier140338FK
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerPREFERRED CARE
# 6
Identifier6290494
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerINDEPENDENT HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: