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NPI Code Detail

MEDICARE: WNY PEACEFUL WARRIOR LLC

MEDICARE: WNY PEACEFUL WARRIOR LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1104398486
Entity Type Code : Organization
Provider Name (Legal Business Name) : WNY PEACEFUL WARRIOR LLC
Provider Business Mailing Address
First Line : 6225 SHERIDAN DR STE 110
Second Line :
City : AMHERST
State : NY
Zip : 14221-4800
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6225 SHERIDAN DR STE 110
Second Line :
City : AMHERST
State : NY
Zip : 14221-4800
Country : US
Telephone Number : 585-301-2983
Fax Number :
Authorized Official
Title or Position : SOLE MBR
Name : JESSICA MARMION
Credential : LCSW-R
Telephone Number : 585-301-2983
Provider Enumeration Date : 12/26/2018
Last Update Date : 12/26/2018

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Directions to “WNY PEACEFUL WARRIOR LLC ” Practice Location

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