Healthcare Provider Details

I. General information

NPI: 1902100183
Provider Name (Legal Business Name): ALICIA MARIE LAIBLE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E AMHERST ST
BUFFALO NY
14214-1804
US

IV. Provider business mailing address

3020 BAILEY AVE
BUFFALO NY
14215-2814
US

V. Phone/Fax

Practice location:
  • Phone: 716-834-6401
  • Fax:
Mailing address:
  • Phone: 716-831-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: