Healthcare Provider Details

I. General information

NPI: 1386211779
Provider Name (Legal Business Name): ELISA JEANNE YAMONACO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2021
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W HUMBOLDT PKWY
BUFFALO NY
14214-2604
US

IV. Provider business mailing address

255 DELAWARE AVE STE 300
BUFFALO NY
14202-2017
US

V. Phone/Fax

Practice location:
  • Phone: 716-710-5151
  • Fax: 716-883-0687
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 Number013952
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: