MEDICARE: WILLOW GROVE COUNSELING, 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1326724782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW GROVE COUNSELING, LCSW, PLLC

Provider Business Mailing Address
First Line	:	166 JEWETT PKWY
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14214-2336
Country	:	US
Telephone Number	:	716-225-4789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1965 SHERIDAN DR FL 2
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14223-1251
Country	:	US
Telephone Number	:	716-225-4789
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER / COUNSELOR
Name	:	MR. WAYNE N. BROWN
Credential	:	LCSW, EDM
Telephone Number	:	716-225-4789

Provider Enumeration Date	:	06/22/2023
Last Update Date	:	06/22/2023

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