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General NPI Number Information
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NPI Number | 1730895897
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Entity Type | Individual
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Provider Name | COREY ROBERT HAERTEL LMSW
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Gender | Male
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 438 MAIN ST STE 1200
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City | BUFFALO
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State | NY
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Zip | 14202-3207
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Country | US
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Telephone | 716-853-3087
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Fax |
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Provider Business Mailing Address
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Address Line | 215 S MAIN ST
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City | ANGOLA
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State | NY
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Zip | 14006-1533
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Country | US
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Telephone | 716-474-8927
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 128263
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License Number State | NY
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