Healthcare Provider Details

I. General information

NPI: 1184821951
Provider Name (Legal Business Name): LYNETTE LEAH LEX-HODGSON MS, LCAT, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 BROADWAY ST
ALDEN NY
14004-9454
US

IV. Provider business mailing address

11901 BROADWAY ST
ALDEN NY
14004-9454
US

V. Phone/Fax

Practice location:
  • Phone: 716-937-3300
  • Fax: 716-937-3300
Mailing address:
  • Phone: 716-937-3300
  • Fax: 716-937-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number000254
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: