Healthcare Provider Details

I. General information

NPI: 1962596718
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF BUFFALO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 W. HUMBOLDT PARKWAY
BUFFALO NY
14214
US

IV. Provider business mailing address

741 DELAWARE AVE
BUFFALO NY
14209-2201
US

V. Phone/Fax

Practice location:
  • Phone: 716-856-4494
  • Fax: 716-842-1277
Mailing address:
  • Phone: 716-218-1450
  • Fax: 716-332-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DENNIS WALCZYK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 716-218-1450