Healthcare Provider Details

I. General information

NPI: 1760548846
Provider Name (Legal Business Name): SUSAN DIANE WOLOSZYN LCSWR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2006
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 WALDEN AVE SUITE 400
CHEEKTOWAGA NY
14225-4965
US

IV. Provider business mailing address

1526 WALDEN AVE SUITE 400
CHEEKTOWAGA NY
14225-4965
US

V. Phone/Fax

Practice location:
  • Phone: 716-895-7167
  • Fax: 716-332-4488
Mailing address:
  • Phone: 716-895-7167
  • Fax: 716-332-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR039344-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: