Provider Demographics
NPI:1730198474
Name:COX, SALLY (LCSWR)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5734
Mailing Address - Country:US
Mailing Address - Phone:716-565-1510
Mailing Address - Fax:
Practice Address - Street 1:5820 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-5734
Practice Address - Country:US
Practice Address - Phone:716-565-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0206451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000500843001OtherBCBS
NM52300OtherCIGNA BEHAVIORAL HC
NY0005743OtherGHI
NY008413Medicare ID - Type Unspecified