Healthcare Provider Details

I. General information

NPI: 1952773707
Provider Name (Legal Business Name): SARAH MANNING BROTHWELL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 LINDEN AVE
EAST AURORA NY
14052-2915
US

IV. Provider business mailing address

374 WEST AVE APT 1
BUFFALO NY
14201-1047
US

V. Phone/Fax

Practice location:
  • Phone: 716-200-7767
  • Fax:
Mailing address:
  • Phone: 716-200-7767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number008670
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: