Healthcare Provider Details

I. General information

NPI: 1437739224
Provider Name (Legal Business Name): BLACKBIRD COUNSELING, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1487 CAMBRIDGE AVE # A
NORTH TONAWANDA NY
14120-1803
US

IV. Provider business mailing address

1487 CAMBRIDGE AVE # A
NORTH TONAWANDA NY
14120-1803
US

V. Phone/Fax

Practice location:
  • Phone: 716-930-4137
  • Fax:
Mailing address:
  • Phone: 716-930-4137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN J FRITZ
Title or Position: PRESIDENT
Credential: LCSW
Phone: 716-930-4137