Healthcare Provider Details

I. General information

NPI: 1578038147
Provider Name (Legal Business Name): CODY ADAM BARBER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3176 ABBOT RD BUILDING A, SUITE 500
ORCHARD PARK NY
14127
US

IV. Provider business mailing address

3176 ABBOT RD., BUILDING A, SUITE 500
ORCHARD PARK NY
14127
US

V. Phone/Fax

Practice location:
  • Phone: 716-822-2177
  • Fax:
Mailing address:
  • Phone: 716-822-2177
  • Fax: 716-822-8165

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: