Healthcare Provider Details

I. General information

NPI: 1386580934
Provider Name (Legal Business Name): MELISSA KUBACKI, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 WEHRLE DR STE 1
BUFFALO NY
14221-7385
US

IV. Provider business mailing address

2809 WEHRLE DR STE 1
WILLIAMSVILLE NY
14221-7385
US

V. Phone/Fax

Practice location:
  • Phone: 716-486-9182
  • Fax: 716-408-7649
Mailing address:
  • Phone: 716-486-9182
  • Fax: 716-408-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ELIZABETH KUBACKI
Title or Position: OWNER
Credential: LCSW
Phone: 716-486-9182