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General NPI Number Information
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NPI Number | 1164508701
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Entity Type | Individual
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Provider Name | DEBRA LEE RETZLAFF
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Gender | Female
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 89 RIVER RD # B
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-5713
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Country | US
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Telephone | 716-693-9961
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Fax |
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Provider Business Mailing Address
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Address Line | 2031 OLD COOMER RD
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City | BURT
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State | NY
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Zip | 14028-9735
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Country | US
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Telephone | 716-778-8337
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Fax |
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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 | 068990
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License Number State | NY
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