Healthcare Provider Details

I. General information

NPI: 1972187409
Provider Name (Legal Business Name): DR. HE WEON SEO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

32 HIGHLAND AVE
BUFFALO NY
14222-1814
US

IV. Provider business mailing address

32 HIGHLAND AVE
BUFFALO NY
14222-1814
US

V. Phone/Fax

Practice location:
  • Phone: 716-579-5409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number020481
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: