Healthcare Provider Details

I. General information

NPI: 1104391762
Provider Name (Legal Business Name): CHELSIE JUNE CIMINELLI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 ORCHARD PARK RD
WEST SENECA NY
14224-4029
US

IV. Provider business mailing address

4577 GENTWOOD DR
WILLIAMSVILLE NY
14221-6117
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-3250
  • Fax:
Mailing address:
  • Phone: 716-207-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number103387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: