Provider Demographics
NPI:1134149982
Name:CHIPPS, JOAN M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:M
Last Name:CHIPPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 BAILEY AVE
Mailing Address - Street 2:116B
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1129
Mailing Address - Country:US
Mailing Address - Phone:716-862-3123
Mailing Address - Fax:716-862-6816
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:116B
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-862-3123
Practice Address - Fax:716-862-6816
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055255-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical