Provider Demographics
NPI:1215903604
Name:GIANCARLO, EILEEN MASTRANGELO (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:MASTRANGELO
Last Name:GIANCARLO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SARANAC AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2443
Mailing Address - Country:US
Mailing Address - Phone:716-833-8800
Mailing Address - Fax:717-876-5730
Practice Address - Street 1:1631 HERTEL AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2908
Practice Address - Country:US
Practice Address - Phone:716-833-8800
Practice Address - Fax:716-876-5730
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR015505-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0806Medicare ID - Type Unspecified