Healthcare Provider Details

I. General information

NPI: 1699003574
Provider Name (Legal Business Name): CHERYL SUSAN MILLS LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 WALDEN AVENUE SUITE 400
CHEEKTOWAGA NY
14225-4985
US

IV. Provider business mailing address

1526 WALDEN AVENUE SUITE 400
CHEEKTOWAGA NY
14225-4985
US

V. Phone/Fax

Practice location:
  • Phone: 716-895-6700
  • Fax: 716-332-4488
Mailing address:
  • Phone: 716-895-6700
  • Fax: 716-332-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR038817-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: