Healthcare Provider Details

I. General information

NPI: 1326665530
Provider Name (Legal Business Name): MARRIAGE AND FAMILY THERAPY OF WNY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 MAIN ST
EAST AURORA NY
14052-1703
US

IV. Provider business mailing address

507 MAIN ST
EAST AURORA NY
14052-1703
US

V. Phone/Fax

Practice location:
  • Phone: 716-241-1524
  • Fax: 716-608-1422
Mailing address:
  • Phone: 716-241-1524
  • Fax: 716-608-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DARCI BETH CRAMER
Title or Position: OWNER
Credential: PHD
Phone: 716-998-3730