Healthcare Provider Details

I. General information

NPI: 1346563996
Provider Name (Legal Business Name): STEPHANIE ANN COFFTA LCSWR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LINWOOD AVE
WILLIAMSVILLE NY
14221-6501
US

IV. Provider business mailing address

15 SYLVAN PKWY
AKRON NY
14001-1513
US

V. Phone/Fax

Practice location:
  • Phone: 716-565-2140
  • Fax: 716-626-4271
Mailing address:
  • Phone: 716-238-5808
  • Fax: 716-626-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number063026-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: