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General NPI Number Information
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NPI Number | 1851987341
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Entity Type | Organization
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Legal Business Name | BLUEBIRD TELESHRINK
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Dates
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Enumeration Date | 12/18/2020
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 4087 TONAWANDA CREEK RD
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-9505
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Country | US
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Telephone | 716-698-7097
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 206
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City | AMHERST
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State | NY
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Zip | 14226-0206
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Country | US
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Telephone | 716-698-7097
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIMBERLY SILLA
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Credential |
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Telephone | 716-698-7097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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