=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295507283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISABETH KATHRYN PARKER MSW, MRT, IAYT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2023
-----------------------------------------------------
Last Update Date | 10/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8610 TRANSIT RD STE 500
-----------------------------------------------------
City | EAST AMHERST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14051-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-458-0382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 SHEPARD AVE UPPR
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14217-1952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-263-6626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------