Healthcare Provider Details

I. General information

NPI: 1982138343
Provider Name (Legal Business Name): LIZA NOBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NIAGARA ST
BUFFALO NY
14213-2116
US

IV. Provider business mailing address

29 MOORE ST APT 15N
BROOKLYN NY
11206-3914
US

V. Phone/Fax

Practice location:
  • Phone: 716-884-0700
  • Fax: 716-884-0631
Mailing address:
  • Phone: 201-362-1415
  • Fax: 716-884-0631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number012065
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: