Healthcare Provider Details

I. General information

NPI: 1144475195
Provider Name (Legal Business Name): THOMAS IRELAND LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 MAIN ST
BUFFALO NY
14202-3203
US

IV. Provider business mailing address

460 MAIN ST
BUFFALO NY
14202-3203
US

V. Phone/Fax

Practice location:
  • Phone: 716-855-0163
  • Fax: 716-855-2023
Mailing address:
  • Phone: 716-855-0163
  • Fax: 716-855-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00046370
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: