Healthcare Provider Details

I. General information

NPI: 1083727648
Provider Name (Legal Business Name): DAVID D PLISS DMIN, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 COLVIN BLVD STE 102
TONAWANDA NY
14150-6973
US

IV. Provider business mailing address

167 FLETCHER ST
TONAWANDA NY
14150-2146
US

V. Phone/Fax

Practice location:
  • Phone: 716-837-8333
  • Fax: 716-837-3050
Mailing address:
  • Phone: 716-743-2043
  • Fax: 716-837-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073307-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: