Healthcare Provider Details

I. General information

NPI: 1366707143
Provider Name (Legal Business Name): ROSEN, BRANDT-DOUGLAS, LCSW,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MARKET ST SUITE 508 - THE BEWLEY BUILDING
LOCKPORT NY
14094-2914
US

IV. Provider business mailing address

20 MARKET ST SUITE 508 - THE BEWLEY BUILDING
LOCKPORT NY
14094-2914
US

V. Phone/Fax

Practice location:
  • Phone: 716-434-7430
  • Fax: 716-434-2300
Mailing address:
  • Phone: 716-434-7430
  • Fax: 716-434-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. SARAH DOUGLAS
Title or Position: PARTNER
Credential: LCSW
Phone: 716-434-7430