1710937644 NPI number — TINA B. ANZALONE LCSW-R

Table of content: TINA B. ANZALONE LCSW-R (NPI 1710937644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710937644 NPI number — TINA B. ANZALONE LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANZALONE
Provider First Name:
TINA
Provider Middle Name:
B.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710937644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3982 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14226-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-839-4406
Provider Business Practice Location Address Fax Number:
716-839-4082
Provider Enumeration Date:
05/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  00041638 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00059030300 . This is a "BLUECROSS/BLUESHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00030241501 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".