Basic Information
| Provider Information | |||||||||
| NPI: | 1710110770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOOTH | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LMSW, CASAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 DELAWARE AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142022016 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3176 ABBOTT RD | ||||||||
| Address2: | BLDG. A, SUITE 500 | ||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141271069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168222117 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2009 | ||||||||
| LastUpdateDate: | 03/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 28904 | NY | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | 8188487 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.