Healthcare Provider Details

I. General information

NPI: 1245848704
Provider Name (Legal Business Name): JANNA BUELL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANNA MORRISON

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MACE RD
GILBOA NY
12076-2600
US

IV. Provider business mailing address

108 MACE RD
GILBOA NY
12076-2600
US

V. Phone/Fax

Practice location:
  • Phone: 518-301-5512
  • Fax:
Mailing address:
  • Phone: 518-301-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: