Healthcare Provider Details

I. General information

NPI: 1841077013
Provider Name (Legal Business Name): ANNA BELLA MUNDY MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SYMPHONY CIR
BUFFALO NY
14201-1363
US

IV. Provider business mailing address

170 S 2ND ST
LEWISTON NY
14092-1511
US

V. Phone/Fax

Practice location:
  • Phone: 716-783-3100
  • Fax: 716-783-3130
Mailing address:
  • Phone: 716-201-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: