Healthcare Provider Details

I. General information

NPI: 1598485963
Provider Name (Legal Business Name): KATHERINE ELIZABETH WILSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 SWEET HOME RD STE 3
AMHERST NY
14228-2795
US

IV. Provider business mailing address

1412 SWEET HOME RD STE 3
AMHERST NY
14228-2795
US

V. Phone/Fax

Practice location:
  • Phone: 716-589-1411
  • Fax: 716-204-0670
Mailing address:
  • Phone: 716-589-1411
  • Fax: 716-204-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: