Basic Information
Provider Information
NPI: 1003139783
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MENEGAUX
FirstName: CONSTANCE
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: MLSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3350 MAIN ST
Address2:  
City: BUFFALO
State: NY
PostalCode: 142141316
CountryCode: US
TelephoneNumber: 7168354011
FaxNumber: 7168350253
Practice Location
Address1: 301 CAYUGA RD
Address2: SUITE 200
City: CHEEKTOWAGA
State: NY
PostalCode: 142251950
CountryCode: US
TelephoneNumber: 7168193420
FaxNumber: 7168193430
Other Information
ProviderEnumerationDate: 03/09/2010
LastUpdateDate: 11/02/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X  Y Behavioral Health & Social Service ProvidersSocial Worker 
1041C0700X064830-1NYN Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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