Healthcare Provider Details

I. General information

NPI: 1861302762
Provider Name (Legal Business Name): LEARNING DISABILITIES ASSOCIATION OF WESTERN NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 MAIN STREET SUITE 342
BUFFALO NY
14214
US

IV. Provider business mailing address

2495 MAIN STREET SUITE 342
BUFFALO NY
14214
US

V. Phone/Fax

Practice location:
  • Phone: 716-710-5460
  • Fax: 716-901-8800
Mailing address:
  • Phone: 716-710-5460
  • Fax: 716-901-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAYLEI E NICKERSON
Title or Position: DIRECTOR OF FINANCE
Credential: CPA, CMA
Phone: 716-710-5460