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General NPI Number Information
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NPI Number | 1326724782
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Entity Type | Organization
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Legal Business Name | WILLOW GROVE COUNSELING, LCSW, PLLC
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Dates
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Enumeration Date | 06/22/2023
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 1965 SHERIDAN DR FL 2
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City | TONAWANDA
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State | NY
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Zip | 14223-1251
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Country | US
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Telephone | 716-225-4789
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Fax |
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Provider Business Mailing Address
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Address Line | 166 JEWETT PKWY
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City | BUFFALO
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State | NY
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Zip | 14214-2336
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Country | US
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Telephone | 716-225-4789
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Fax |
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Authorized Official
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Title or Position | FOUNDER / COUNSELOR
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Name | MR. WAYNE N. BROWN
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Credential | LCSW, EDM
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Telephone | 716-225-4789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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