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General NPI Number Information
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NPI Number | 1407559669
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Entity Type | Organization
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Legal Business Name | KALEIDOSCOPE LIVING
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 425 SAINT LAWRENCE AVE LOWR
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City | BUFFALO
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State | NY
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Zip | 14216-1418
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Country | US
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Telephone | 716-906-7585
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Fax |
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Provider Business Mailing Address
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Address Line | 425 SAINT LAWRENCE AVE LOWR
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City | BUFFALO
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State | NY
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Zip | 14216-1418
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Country | US
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Telephone | 716-906-7585
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. NICOLE L JORDAN
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Credential | LCSW
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Telephone | 716-906-7585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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