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General NPI Number Information
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NPI Number | 1497349567
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Entity Type | Organization
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Legal Business Name | GAY AND LESBIAN YOUTH SERVICES OF WNY
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Dates
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Enumeration Date | 03/01/2021
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 278 DELAWARE AVE
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City | BUFFALO
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State | NY
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Zip | 14202-1801
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Country | US
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Telephone | 716-855-0221
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Fax |
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Provider Business Mailing Address
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Address Line | 278 DELAWARE AVE
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City | BUFFALO
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State | NY
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Zip | 14202-1801
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Country | US
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Telephone | 716-855-0221
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/CEO
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Name | DR. ROBERT ROUSH
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Credential | PHD
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Telephone | 716-855-0221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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