Provider Demographics
NPI:1730895897
Name:HAERTEL, COREY ROBERT
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:ROBERT
Last Name:HAERTEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-1533
Mailing Address - Country:US
Mailing Address - Phone:716-474-8927
Mailing Address - Fax:
Practice Address - Street 1:438 MAIN ST STE 1200
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3207
Practice Address - Country:US
Practice Address - Phone:716-853-3087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker