Healthcare Provider Details

I. General information

NPI: 1164243036
Provider Name (Legal Business Name): OTHER POSSIBILITIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 HERTEL AVE APT D
BUFFALO NY
14207-2351
US

IV. Provider business mailing address

PO BOX 781
BUFFALO NY
14207-0781
US

V. Phone/Fax

Practice location:
  • Phone: 716-785-2441
  • Fax:
Mailing address:
  • Phone: 716-785-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: RIVER-AAERIN ANATINUS NIAHLL
Title or Position: OWNER
Credential: LMFT
Phone: 716-785-2441