Healthcare Provider Details

I. General information

NPI: 1225465115
Provider Name (Legal Business Name): LAURA LYNN NERATKO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 WEST MAIN ST.
BROCTON NY
14716
US

IV. Provider business mailing address

138 WEST MAIN ST.
BROCTON NY
14716
US

V. Phone/Fax

Practice location:
  • Phone: 716-792-2140
  • Fax:
Mailing address:
  • Phone: 716-792-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081018-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: