Provider Demographics
NPI:1366541120
Name:PANEK, CHERI ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:ANN
Last Name:PANEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7592 HEALY ROAD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-8215
Mailing Address - Country:US
Mailing Address - Phone:315-253-8109
Mailing Address - Fax:
Practice Address - Street 1:157 GENESEE STREET
Practice Address - Street 2:BASEMENT
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3461
Practice Address - Country:US
Practice Address - Phone:315-253-0341
Practice Address - Fax:315-253-1129
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY54405651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA9439Medicare ID - Type Unspecified