Healthcare Provider Details

I. General information

NPI: 1043255417
Provider Name (Legal Business Name): TAMMI LYNN VON WRYEZA-RAS MSEDC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-1693
US

IV. Provider business mailing address

2680 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-1693
US

V. Phone/Fax

Practice location:
  • Phone: 716-775-7566
  • Fax:
Mailing address:
  • Phone: 716-775-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: