Healthcare Provider Details

I. General information

NPI: 1285808873
Provider Name (Legal Business Name): AMANDA RAE RUSCH LMHC, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SWEET HOME RD
BUFFALO NY
14228-2777
US

IV. Provider business mailing address

1400 SWEET HOME RD
BUFFALO NY
14228-2777
US

V. Phone/Fax

Practice location:
  • Phone: 716-449-0494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25988
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004983-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: