Healthcare Provider Details

I. General information

NPI: 1124418306
Provider Name (Legal Business Name): GATEWAY-LONGVIEW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SYMPHONY CIR
BUFFALO NY
14201-1363
US

IV. Provider business mailing address

297 PARAMOUNT PKWY
BUFFALO NY
14223-1074
US

V. Phone/Fax

Practice location:
  • Phone: 716-783-3230
  • Fax:
Mailing address:
  • Phone: 716-725-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number867311141
License Number StateNY

VIII. Authorized Official

Name: CARMELINA BUFALINO
Title or Position: SCHOOL PSYCHOLOGIST
Credential: MS, CAS
Phone: 716-783-3230