=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104391762
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSIE JUNE CIMINELLI LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2018
-----------------------------------------------------
Last Update Date | 10/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1397 ORCHARD PARK RD
-----------------------------------------------------
City | WEST SENECA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14224-4029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-677-3250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4577 GENTWOOD DR
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-6117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-207-0340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number | 103387
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------