Healthcare Provider Details

I. General information

NPI: 1336679869
Provider Name (Legal Business Name): MARCELLA MOSLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 MAIN ST STE 1
WILLIAMSVILLE NY
14221-6054
US

IV. Provider business mailing address

8205 MAIN ST STE 1
WILLIAMSVILLE NY
14221-6054
US

V. Phone/Fax

Practice location:
  • Phone: 716-867-5027
  • Fax:
Mailing address:
  • Phone: 716-867-5027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090898
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: