MEDICARE: CAROL J CREIGHTON LCSW

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	PR011345-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000500044001	OTHER	NY	HEALTH NOW

General Provider Information

NPI Number	:	1710971361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL J CREIGHTON LCSW

Provider Business Mailing Address
First Line	:	1837 HERTEL AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-3006
Country	:	US
Telephone Number	:	716-834-0990
Fax Number	:	716-834-5116

Provider Business Practice Location Address
First Line	:	1837 HERTEL AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-3006
Country	:	US
Telephone Number	:	716-834-0990
Fax Number	:	716-834-5116

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/09/2012

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