Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 077550 | NY |
NPI | 1003264805 |
---|---|
Provider Name | Traci L Bender |
First Address | Buffalo, NY 14207-1816 |
Second Address | Buffalo, NY 14207-1816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2016 |
Last Update Date | 02/06/2016 |