Healthcare Provider Details

I. General information

NPI: 1619416310
Provider Name (Legal Business Name): AMANDA NICHOLE KASTELIC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 09/23/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14014 ROUTE 31
ALBION NY
14411
US

IV. Provider business mailing address

800 HERTEL AVE STE 101
BUFFALO NY
14207-1906
US

V. Phone/Fax

Practice location:
  • Phone: 585-589-7066
  • Fax: 585-589-6395
Mailing address:
  • Phone: 716-566-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number102556-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: