Healthcare Provider Details

I. General information

NPI: 1639127236
Provider Name (Legal Business Name): KATHLEEN M. REDDISH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 DELAWARE AVE
KENMORE NY
14217-1425
US

IV. Provider business mailing address

525 WASHINGTON ST MANAGED CARE DEPARTMENT
BUFFALO NY
14203-1711
US

V. Phone/Fax

Practice location:
  • Phone: 716-877-8822
  • Fax: 716-874-5245
Mailing address:
  • Phone: 716-856-4494
  • Fax: 716-842-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00072544
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: