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General NPI Number Information
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NPI Number | 1578339354
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Entity Type | Organization
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Legal Business Name | RENOVATED SOUL MARRIAGE AND FAMILY THERAPY, PLLC
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 331 ALBERTA DR STE 115
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City | BUFFALO
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State | NY
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Zip | 14226-1813
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Country | US
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Telephone | 716-787-1983
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Fax |
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Provider Business Mailing Address
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Address Line | 1404 SWEET HOME RD STE 2
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City | AMHERST
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State | NY
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Zip | 14228-2778
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Country | US
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Telephone | 716-787-1983
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHERITA DANIELLE ANDERSON-BAILEY
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Credential | LMFT
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Telephone | 716-994-8698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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