Healthcare Provider Details

I. General information

NPI: 1932425519
Provider Name (Legal Business Name): KATHY A WICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 DELAWARE AVE
BUFFALO NY
14209-2260
US

IV. Provider business mailing address

737 DELAWARE AVE
BUFFALO NY
14209-2260
US

V. Phone/Fax

Practice location:
  • Phone: 716-885-9894
  • Fax: 716-885-9897
Mailing address:
  • Phone: 716-885-9894
  • Fax: 716-885-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP058650-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: