Healthcare Provider Details

I. General information

NPI: 1760393128
Provider Name (Legal Business Name): MCBRIDE COGNITIVE IMPROVEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 W LAKE RD
WILSON NY
14172-9626
US

IV. Provider business mailing address

2833 W LAKE RD
WILSON NY
14172-9626
US

V. Phone/Fax

Practice location:
  • Phone: 716-341-8548
  • Fax:
Mailing address:
  • Phone: 716-341-8548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE MCBRIDE
Title or Position: SPECIAL EDUCATION TEACHER
Credential: MS, ED
Phone: 716-341-8548