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General NPI Number Information
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NPI Number | 1346424520
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Entity Type | Organization
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Legal Business Name | LAKE SHORE BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 12/24/2007
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Provider Practice Location Address
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Address Line | LAKE SHORE BEHAVIORAL HEALTH 254 FRANKLIN STREET
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City | BUFFALO
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State | NY
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Zip | 14202
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Country | US
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Telephone | 716-842-0440
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Fax | 716-842-4069
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Provider Business Mailing Address
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Address Line | 430 NIAGARA ST
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City | BUFFALO
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State | NY
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Zip | 14201-1886
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Country | US
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Telephone | 716-842-0440
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Fax | 716-842-4069
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HOWARD HITZEL
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Credential | PSY. D.
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Telephone | 716-842-0440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 02732658
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License Number State | NY
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