Individual
MS. CAROL A CONKLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW-R
Contact information
Practice address
610 ASHLAND AVE, BUFFALO, NY 14222-1309
(716) 883-7713
(716) 883-6718
Mailing address
610 ASHLAND AVE, BUFFALO, NY 14222-1309
(716) 883-7713
(716) 883-6718
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R055959-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00020965201
UNIVERA PROVIDER #
NY
01
—
000526017001
BC BS BUFFALO
NY
01
—
000526017002
BC BS NATIONAL
NY
01
—
161587546
TRICARE PROVIDER #
NY
Enumeration date
03/07/2006
Last updated
10/19/2016
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