MEDICARE: R.E.FOSTER,LCSW,PLLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1144709445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R.E.FOSTER,LCSW,PLLC

Provider Business Mailing Address
First Line	:	1201 COLVIN BLVD STE 6
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1936
Country	:	US
Telephone Number	:	716-400-0762
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 COLVIN BLVD STE 6
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1936
Country	:	US
Telephone Number	:	716-400-0762
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RYANN FOSTER
Credential	:	LCSWR
Telephone Number	:	716-400-0762

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	08/08/2018

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