Healthcare Provider Details

I. General information

NPI: 1740046788
Provider Name (Legal Business Name): ALDEN MENTAL HEALTH COUNSELING WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
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:
Mailing address:
  • Phone: 716-937-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ERIN RUSTON
Title or Position: OWNER/LICENSED MENTAL HEALTH COUNSE
Credential:
Phone: 716-937-3300