Healthcare Provider Details

I. General information

NPI: 1588628267
Provider Name (Legal Business Name): ERIC D. DRYJA LCSWR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 N MAIN ST
WARSAW NY
14569-1326
US

IV. Provider business mailing address

227 THORN AVE
ORCHARD PARK NY
14127-2600
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-0220
  • Fax: 585-786-3631
Mailing address:
  • Phone: 716-662-2040
  • Fax: 716-662-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number078395
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: