Healthcare Provider Details

I. General information

NPI: 1306471214
Provider Name (Legal Business Name): MARY LYNN PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 ELM ST
BUFFALO NY
14203-1621
US

IV. Provider business mailing address

291 ELM ST
BUFFALO NY
14203-1621
US

V. Phone/Fax

Practice location:
  • Phone: 716-854-2444
  • Fax: 716-854-4671
Mailing address:
  • Phone: 716-854-2444
  • Fax: 716-854-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: