Provider Demographics
NPI:1144286071
Name:MIERS, TRACEY C (LCSW-R)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:C
Last Name:MIERS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2201
Mailing Address - Country:US
Mailing Address - Phone:716-218-1450
Mailing Address - Fax:716-332-2820
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4948
Practice Address - Country:US
Practice Address - Phone:716-648-6515
Practice Address - Fax:716-648-7101
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00000381741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00030241501OtherUNIVERA
NY040426031053OtherFIDELIS
NY6211350OtherINDEPENDENT HEALTH
NY160743251-58OtherPRISM
NY000523549003OtherBLUECROSS/BLUESHIELD
NY6211350OtherINDEPENDENT HEALTH