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General NPI Number Information
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NPI Number | 1568087146
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Entity Type | Organization
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Legal Business Name | TRANQUIL WATERS COUNSELING (LCSW) PLLC
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 4535 SOUTHWESTERN BLVD STE 706A
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City | HAMBURG
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State | NY
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Zip | 14075-1870
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Country | US
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Telephone | 716-449-0494
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Fax |
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Provider Business Mailing Address
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Address Line | 6252 TUPELO LN
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City | LAKE VIEW
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State | NY
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Zip | 14085-9472
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Country | US
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Telephone | 716-713-3532
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | CHERI L. DIETZ
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Credential | LCSW-R
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Telephone | 716-449-0494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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