Basic Information
| Provider Information | |||||||||
| NPI: | 1720043680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLEXENKO | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSWR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2128 ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168744500 | ||||||||
| FaxNumber: | 7168748145 | ||||||||
| Practice Location | |||||||||
| Address1: | 2128 ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168744500 | ||||||||
| FaxNumber: | 7168748145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R047691 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 000526001001 | 01 | FAMILY HEALTH PLUS | OTHER | 050730000006 | 01 | FIDELIS FAMILY HEALTH PLS | OTHER | 000526001001 | 01 | CHILD HEALTH PLUS | OTHER | 000526001001 | 01 | COMM CARE MEDICAID MGD C | OTHER | 000526001001 | 01 | HMO 100 | OTHER | 00011249905 | 01 | ASO | OTHER | 000526001001 | 01 | HEALTHLY NY | OTHER | 000526001001 | 01 | BCBS WNY | OTHER | 000526001001 | 01 | COMMUNITY BLUE STD HMO | OTHER | 000526001001 | 01 | SECURE BLUE POS | OTHER | 000526001001 | 01 | CB ADVANTAGE HMO | OTHER | 000526001001 | 01 | SECURE BLUE PPO | OTHER | 000526001001 | 01 | SECURE BLUE INDEMNITY | OTHER | 050730000006 | 01 | FIDELIS CHILD HEALTH PLUS | OTHER | 000526001001 | 01 | CB LABOR HEALTH HMO | OTHER | 000526001001 | 01 | SENIOR BLUE HMO | OTHER | 050730000006 | 01 | FIDELIS MEDICAID | OTHER | 01465154 | 05 | NY | MEDICAID |