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General NPI Number Information
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NPI Number | 1578827754
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Entity Type | Organization
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Legal Business Name | PARTNERS IN HEALING
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 229 MAIN ST UPPER LEVEL
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City | HAMBURG
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State | NY
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Zip | 14075-4915
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Country | US
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Telephone | 716-548-6190
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Fax |
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Provider Business Mailing Address
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Address Line | 159 PLEASANT AVE
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City | HAMBURG
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State | NY
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Zip | 14075-4827
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Country | US
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Telephone | 716-548-6190
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | JILL GAVIN GANNON
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Credential | RN,BC, BHSP
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Telephone | 716-548-6190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 268088
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 268088
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License Number State | NY
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