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NPI Code Detail

MEDICARE: MS. CASSANDRA GENNUSO LCPC

MEDICARE: MS. CASSANDRA GENNUSO LCPC
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
1101YM0800XMental Health Counselor016714NY

General Provider Information

NPI Number : 1134732886
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CASSANDRA GENNUSO LCPC
Provider Business Mailing Address
First Line : 227 THORN AVE STE 19
Second Line :
City : ORCHARD PARK
State : NY
Zip : 14127-2677
Country : US
Telephone Number : 716-662-2040
Fax Number : 716-662-0019
Provider Business Practice Location Address
First Line : 1298 MAIN ST FL 3
Second Line :
City : BUFFALO
State : NY
Zip : 14209-1946
Country : US
Telephone Number : 716-884-5797
Fax Number : 716-882-0293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2020
Last Update Date : 05/20/2026

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