Healthcare Provider Details

I. General information

NPI: 1184303133
Provider Name (Legal Business Name): KYM LATRICE CARTER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 FRANKLIN ST
BUFFALO NY
14202-1932
US

IV. Provider business mailing address

22 N OGDEN ST
BUFFALO NY
14206-1429
US

V. Phone/Fax

Practice location:
  • Phone: 716-551-7894
  • Fax: 716-840-9593
Mailing address:
  • Phone: 716-748-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number104776-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: