Healthcare Provider Details

I. General information

NPI: 1467007401
Provider Name (Legal Business Name): SHAUN CRIMMINS LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 ALBERTA DR STE 108
AMHERST NY
14226-1813
US

IV. Provider business mailing address

331 ALBERTA DR STE 108
AMHERST NY
14226-1813
US

V. Phone/Fax

Practice location:
  • Phone: 716-650-4797
  • Fax: 716-608-1437
Mailing address:
  • Phone: 716-650-4797
  • Fax: 716-608-1437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier04033776
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: SHAUN CRIMMINS
Title or Position: OWNER/PROVIDER
Credential: LCSW-R
Phone: 716-650-4797