Healthcare Provider Details

I. General information

NPI: 1437054780
Provider Name (Legal Business Name): AUDREY MARIE MARIE HUSENITZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 MAIN ST
BUFFALO NY
14203-1109
US

IV. Provider business mailing address

899 MAIN ST
BUFFALO NY
14203-1109
US

V. Phone/Fax

Practice location:
  • Phone: 716-886-5437
  • Fax: 716-886-5888
Mailing address:
  • Phone: 716-886-5437
  • Fax: 716-886-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: