Healthcare Provider Details

I. General information

NPI: 1568333003
Provider Name (Legal Business Name): KELLI COOKFAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 N FRENCH RD STE 7
AMHERST NY
14228-1900
US

IV. Provider business mailing address

238 ELLEN DR
BUFFALO NY
14225-1325
US

V. Phone/Fax

Practice location:
  • Phone: 716-864-7405
  • Fax:
Mailing address:
  • Phone: 716-864-7405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091880
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: