Healthcare Provider Details

I. General information

NPI: 1437629250
Provider Name (Legal Business Name): SANCTUARY COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 KENMORE AVE
BUFFALO NY
14223-2861
US

IV. Provider business mailing address

238 SOUTHSIDE PKWY
BUFFALO NY
14220-1250
US

V. Phone/Fax

Practice location:
  • Phone: 716-361-6792
  • Fax:
Mailing address:
  • Phone: 716-361-6792
  • Fax:

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: AARON J ROSENBAUM
Title or Position: OWNER/THERAPIST
Credential: LCSR-R
Phone: 716-361-6792