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General NPI Number Information
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NPI Number | 1376346403
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Entity Type | Organization
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Legal Business Name | LAKE EFFECT APPLIED BEHAVIOR ANALYSIS PLLC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 4195 ROUTE 219 TRLR 39
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City | SALAMANCA
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State | NY
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Zip | 14779-9603
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Country | US
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Telephone | 716-249-1310
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Fax | 716-828-8266
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Provider Business Mailing Address
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Address Line | 4195 ROUTE 219 TRLR 39
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City | SALAMANCA
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State | NY
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Zip | 14779-9603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CATHERINE MCCLURE
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Credential |
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Telephone | 617-899-8613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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