Healthcare Provider Details

I. General information

NPI: 1467877167
Provider Name (Legal Business Name): MRS. RUBY CAROLINA ORCUTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NIAGARA ST
BUFFALO NY
14213-2116
US

IV. Provider business mailing address

206 S ELMWOOD AVE
BUFFALO NY
14201-2398
US

V. Phone/Fax

Practice location:
  • Phone: 716-884-0700
  • Fax: 716-884-0631
Mailing address:
  • Phone: 716-847-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number05362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: