Healthcare Provider Details

I. General information

NPI: 1093049397
Provider Name (Legal Business Name): BRIAN WOJCIK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GENESEE ST
CHEEKTOWAGA NY
14225-1944
US

IV. Provider business mailing address

330 DELAWARE AVE
BUFFALO NY
14202-1804
US

V. Phone/Fax

Practice location:
  • Phone: 716-335-7015
  • Fax:
Mailing address:
  • Phone: 716-335-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081496-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: