Healthcare Provider Details

I. General information

NPI: 1104967652
Provider Name (Legal Business Name): SUZANNE LYNN MOXHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6495 TRANSIT RD. SUITE 800
EAST AMHERST NY
14051
US

IV. Provider business mailing address

3020 BAILEY AVE - 2ND FLOOR
BUFFALO NY
14215
US

V. Phone/Fax

Practice location:
  • Phone: 716-418-8531
  • Fax: 716-418-8514
Mailing address:
  • Phone: 716-831-1800
  • Fax: 716-842-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number074271-7
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079054
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: