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General NPI Number Information
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NPI Number | 1053328344
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Entity Type | Individual
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Provider Name | JEAN ISABELLA DITTMAN M.S.W., L.C.S.W.-R
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Gender | Female
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 09/10/2009
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Provider Practice Location Address
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Address Line | VA WNY HEALTHCARE SYSTEM/528 3495 BAILEY AVENUE
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City | BUFFALO
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State | NY
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Zip | 14215-0000
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Country | US
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Telephone | 716-862-6016
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Fax | 716-834-7329
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Provider Business Mailing Address
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Address Line | 259 SHERBROOKE AVE
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3422
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Country | US
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Telephone | 716-862-6016
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Fax | 716-834-7329
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R036533-1
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License Number State | NY
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