Healthcare Provider Details

I. General information

NPI: 1609301837
Provider Name (Legal Business Name): ELIZABETH GRUPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH CAMPESE

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60-62 FRANKLIN AVE
DUNKIRK NY
14048
US

IV. Provider business mailing address

2 ACADEMY ST RM 201
MAYVILLE NY
14757-1050
US

V. Phone/Fax

Practice location:
  • Phone: 716-363-3550
  • Fax: 716-753-8716
Mailing address:
  • Phone: 716-753-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number013114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: