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General NPI Number Information
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NPI Number | 1083727648
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Entity Type | Individual
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Provider Name | DAVID D PLISS DMIN, LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1914 COLVIN BLVD STE 102
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City | TONAWANDA
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State | NY
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Zip | 14150-6973
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Country | US
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Telephone | 716-837-8333
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Fax | 716-837-3050
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Provider Business Mailing Address
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Address Line | 167 FLETCHER ST
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City | TONAWANDA
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State | NY
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Zip | 14150-2146
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Country | US
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Telephone | 716-743-2043
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Fax | 716-837-3050
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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 | 073307-01
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License Number State | NY
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