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General NPI Number Information
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NPI Number | 1386094126
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Entity Type | Organization
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Legal Business Name | MARY JO PENIZOTTO, PHD
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 6507 TRANSIT RD STE B
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City | EAST AMHERST
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State | NY
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Zip | 14051-1427
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Country | US
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Telephone | 716-204-0100
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Fax | 716-204-2761
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Provider Business Mailing Address
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Address Line | 6507 TRANSIT RD STE B
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City | EAST AMHERST
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State | NY
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Zip | 14051-1427
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Country | US
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Telephone | 716-204-0100
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Fax | 716-204-2761
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. MARY JO PENIZOTTO
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Credential | PH.D.
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Telephone | 716-204-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 010373-1
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License Number State | NY
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