Healthcare Provider Details

I. General information

NPI: 1487299624
Provider Name (Legal Business Name): MIRIAM CENTER FOR HOPE AND HEALING LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SOUTH CLINTON ST
OLEAN NY
14760
US

IV. Provider business mailing address

112 SOUTH CLINTON ST
OLEAN NY
14760
US

V. Phone/Fax

Practice location:
  • Phone: 716-313-6735
  • Fax: 888-622-1235
Mailing address:
  • Phone: 716-313-6735
  • Fax: 888-622-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARY A PLONKA
Title or Position: PARTNER
Credential: LCSW
Phone: 716-373-6735