Healthcare Provider Details

I. General information

NPI: 1184726218
Provider Name (Legal Business Name): IRMA KATIE RUTH CSWR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 WHITEHAVEN RD
GRAND ISLAND NY
14072-1804
US

IV. Provider business mailing address

1870 WHITEHAVEN RD
GRAND ISLAND NY
14072-1804
US

V. Phone/Fax

Practice location:
  • Phone: 716-773-6181
  • Fax: 716-773-0941
Mailing address:
  • Phone: 716-773-6181
  • Fax: 716-773-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR0234251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: