Healthcare Provider Details

I. General information

NPI: 1144286071
Provider Name (Legal Business Name): TRACEY C. MIERS LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MAIN ST
HAMBURG NY
14075-4948
US

IV. Provider business mailing address

741 DELAWARE AVE
BUFFALO NY
14209-2201
US

V. Phone/Fax

Practice location:
  • Phone: 716-648-6515
  • Fax: 716-648-7101
Mailing address:
  • Phone: 716-218-1450
  • Fax: 716-332-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0000038174
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: