Healthcare Provider Details

I. General information

NPI: 1992585194
Provider Name (Legal Business Name): JENNIFER ELIZABETH HEFFLER PH.D., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 HARLEM RD SUITE #3
BUFFALO NY
14215-2042
US

IV. Provider business mailing address

239 BEWLEY BUILDING
LOCKPORT NY
14094-2942
US

V. Phone/Fax

Practice location:
  • Phone: 716-439-1936
  • Fax: 716-439-1930
Mailing address:
  • Phone: 716-439-1936
  • Fax: 716-439-1930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004786-02
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: