Healthcare Provider Details

I. General information

NPI: 1184820904
Provider Name (Legal Business Name): JUDITH HEFNER LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 NIAGARA ST
BUFFALO NY
14213-1503
US

IV. Provider business mailing address

1300 NIAGARA ST PO BOX 657
BUFFALO NY
14213-1503
US

V. Phone/Fax

Practice location:
  • Phone: 716-882-2127
  • Fax: 716-882-9277
Mailing address:
  • Phone: 716-882-2127
  • Fax: 716-882-9277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR027507-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: