Healthcare Provider Details

I. General information

NPI: 1205378809
Provider Name (Legal Business Name): BESTSELF BEHAVIORAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NIAGARA ST
BUFFALO NY
14213-2116
US

IV. Provider business mailing address

255 DELAWARE AVE SUITE 300
BUFFALO NY
14202-2016
US

V. Phone/Fax

Practice location:
  • Phone: 716-884-0700
  • Fax: 716-884-0631
Mailing address:
  • Phone: 716-842-0440
  • Fax: 716-842-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6783101A
License Number StateNY

VIII. Authorized Official

Name: ELIZABETH WOIKE-GANGA
Title or Position: PRESIDENT/CEO
Credential: LCSW-R
Phone: 716-842-0440