Basic Information
| Provider Information | |||||||||
| NPI: | 1144286071 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIERS | ||||||||
| FirstName: | TRACEY | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | LCSW-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 741 DELAWARE AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142092201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162181450 | ||||||||
| FaxNumber: | 7163322820 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HAMBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140754948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166486515 | ||||||||
| FaxNumber: | 7166487101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 12/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0000038174 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 00030241501 | 01 | NY | UNIVERA | OTHER | 040426031053 | 01 | NY | FIDELIS | OTHER | 6211350 | 01 | NY | INDEPENDENT HEALTH | OTHER | 160743251-58 | 01 | NY | PRISM | OTHER | 000523549003 | 01 | NY | BLUECROSS/BLUESHIELD | OTHER |