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40 Gardenville Pkwy Ste 213 West Seneca NY 14224-1399 | |
| (716) 783-0407 | |
| (716) 393-3430 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 40 Gardenville Pkwy Ste 213, West Seneca, New York |
| Authorized Official Name and Position | Charmaine Ann Fanara (OWNER) |
| Authorized Official Contact | 7167830407 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
59 Alys Dr E Depew NY 14043-1402 Ph: (716) 783-0407 | 40 Gardenville Pkwy Ste 213 West Seneca NY 14224-1399 Ph: (716) 783-0407 |
| NPI Number | 1871884460 |
|---|---|
| Provider Enumeration Date | 04/29/2011 |
| Last Update Date | 04/18/2022 |
| Certification Date | 04/18/2022 |
| Medicare PECOS PAC ID | 0648530550 |
|---|---|
| Medicare Enrollment ID | O20180213002808 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871884460 | NPI | - | NPPES |
| 05054586 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 071265-1 (New York) | Primary |
| Provider Name | Barbara J Christman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538275375 PECOS PAC ID: 8123007028 Enrollment ID: I20040715000147 |
| Provider Name | Charmaine A Fanara |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740378751 PECOS PAC ID: 8820137219 Enrollment ID: I20091124000304 |
| Provider Name | Kristine E Pieczonka |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013292978 PECOS PAC ID: 5193073724 Enrollment ID: I20180730002234 |
| Provider Name | Jennifer M Attea |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164771887 PECOS PAC ID: 2062759905 Enrollment ID: I20190130001324 |
| Provider Name | Corina M Labin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558667550 PECOS PAC ID: 1355774068 Enrollment ID: I20191211002091 |
Vitality Counseling Center Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 40 Gardenville Pkwy W Ste 114, West Seneca, NY 14224 Phone: 716-202-8428 | |