Healthcare Provider Details

I. General information

NPI: 1447248026
Provider Name (Legal Business Name): RION BARRETT KWELLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2005
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MAIN ST SUITE 308
WILLIAMSVILLE NY
14221-6755
US

IV. Provider business mailing address

5500 MAIN ST SUITE 308
WILLIAMSVILLE NY
14221-6755
US

V. Phone/Fax

Practice location:
  • Phone: 716-634-1184
  • Fax: 716-634-3207
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number009373
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number009373
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: