MEDICARE: JAMES C CROGLIO LCSW-R

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	1041C0700X	Clinical Social Worker	00046028	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00030241501	OTHER	NY	UNIVERA

General Provider Information

NPI Number	:	1700936473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES C CROGLIO LCSW-R

Provider Business Mailing Address
First Line	:	525 WASHINGTON ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14203-1711
Country	:	US
Telephone Number	:	716-856-4494
Fax Number	:	716-842-1277

Provider Business Practice Location Address
First Line	:	16 COLUMBUS ST
Second Line	:
City	:	CHEEKTOWAGA
State	:	NY
Zip	:	14227-1251
Country	:	US
Telephone Number	:	716-894-2743
Fax Number	:	716-896-6394

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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