Healthcare Provider Details

I. General information

NPI: 1336067024
Provider Name (Legal Business Name): ALLISON COSTOLNICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON STANTON LMSW

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 DELAWARE AVE
BUFFALO NY
14209-2201
US

IV. Provider business mailing address

1980 MARJORIE RD
GRAND ISLAND NY
14072-2618
US

V. Phone/Fax

Practice location:
  • Phone: 716-432-2600
  • Fax:
Mailing address:
  • Phone: 716-432-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103406
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: