Healthcare Provider Details

I. General information

NPI: 1073645016
Provider Name (Legal Business Name): LAREINE F. HUNGERFORD LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAREINE F. CLOPPER

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ASHLAND AVE
BUFFALO NY
14222-1542
US

IV. Provider business mailing address

415 ASHLAND AVE
BUFFALO NY
14222-1542
US

V. Phone/Fax

Practice location:
  • Phone: 716-881-2296
  • Fax: 716-886-0701
Mailing address:
  • Phone: 716-881-2296
  • Fax: 716-886-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR024662-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: