Provider Demographics
NPI:1730239443
Name:WEBB, MARY CREEL (LCSWR)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CREEL
Last Name:WEBB
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 1:1001 ELEVENTH STREET
Mailing Address - Street 2:TROTT ACCESS CENTER
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-278-1940
Mailing Address - Fax:716-278-1943
Practice Address - Street 1:1001 ELEVENTH STREET
Practice Address - Street 2:TROTT ACCESS CENTER
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-278-1940
Practice Address - Fax:716-278-1943
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0493451104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
000526538002OtherBCBS
000526538002OtherBCBS