Healthcare Provider Details

I. General information

NPI: 1407588940
Provider Name (Legal Business Name): EAST AMHERST PSYCHOLOGY GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 TRANSIT RD
EAST AMHERST NY
14051-1311
US

IV. Provider business mailing address

9750 TRANSIT RD
EAST AMHERST NY
14051-1311
US

V. Phone/Fax

Practice location:
  • Phone: 716-636-1375
  • Fax:
Mailing address:
  • Phone: 716-636-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CARY CHUGH
Title or Position: SECRETARY
Credential: PHD
Phone: 716-636-1375