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General NPI Number Information
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NPI Number | 1114394020
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Entity Type | Organization
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Legal Business Name | STACEY L. DONAHUE, LCSW, PLLC
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 5500 MAIN ST SUITE 209
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6755
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Country | US
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Telephone | 716-308-2443
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Fax | 716-632-0031
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Provider Business Mailing Address
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Address Line | 5500 MAIN ST 209
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6755
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Country | US
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Telephone | 716-308-2443
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Fax | 716-632-0031
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. STACEY LYNN DONAHUE
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Credential | LCSW
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Telephone | 716-308-2443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 056508
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License Number State | NY
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