MEDICARE: SALLY R JANES M.S.W., CGC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1336446780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY R JANES M.S.W., CGC

Provider Business Mailing Address
First Line	:	140 HODGE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14222-2034
Country	:	US
Telephone Number	:	716-878-7545
Fax Number	:	716-878-7405

Provider Business Practice Location Address
First Line	:	140 HODGE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14222-2034
Country	:	US
Telephone Number	:	716-878-7545
Fax Number	:	716-878-7405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	02/22/2011

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