Healthcare Provider Details

I. General information

NPI: 1477577377
Provider Name (Legal Business Name): SANDRA J. MINEO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5067 THOMPSON RD
CLARENCE NY
14031-1435
US

IV. Provider business mailing address

5067 THOMPSON RD
CLARENCE NY
14031-1435
US

V. Phone/Fax

Practice location:
  • Phone: 716-741-4250
  • Fax: 716-741-4250
Mailing address:
  • Phone: 716-741-4250
  • Fax: 716-741-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR019652
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: