Healthcare Provider Details

I. General information

NPI: 1811190374
Provider Name (Legal Business Name): JONI LYNN MAXICK-JASON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DRUG & ALCOHOL ABUSE 951 NIAGARA STREET
BUFFALO NY
14213
US

IV. Provider business mailing address

LAKE SHORE BEHAVIORAL HEALTH, INC. 254 FRANKLIN STREET
BUFFALO NY
14202
US

V. Phone/Fax

Practice location:
  • Phone: 716-883-5344
  • Fax: 716-884-1758
Mailing address:
  • Phone: 716-842-0440
  • Fax: 716-842-4069

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: