Healthcare Provider Details

I. General information

NPI: 1851358709
Provider Name (Legal Business Name): SUSAN F. YEAGER LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 LINDEN AVE
EAST AURORA NY
14052-2915
US

IV. Provider business mailing address

552 LINDEN AVE
EAST AURORA NY
14052-2915
US

V. Phone/Fax

Practice location:
  • Phone: 716-652-8100
  • Fax: 716-655-6077
Mailing address:
  • Phone: 716-652-8100
  • Fax: 716-655-6077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0000033917
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: