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NPI Code Detail

MEDICARE: DR. PAULA IRENE JANICKI PH.D/

MEDICARE: DR. PAULA IRENE JANICKI PH.D/
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
1103T00000XPsychologist013229-1NY

General Provider Information

NPI Number : 1477562429
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAULA IRENE JANICKI PH.D/
Provider Business Mailing Address
First Line : 5500 MAIN STREET
Second Line : SUITE 308
City : WILLIAMSVILLE
State : NY
Zip : 14221-6737
Country : US
Telephone Number : 716-634-1184
Fax Number : 716-634-3207
Provider Business Practice Location Address
First Line : 5500 MAIN STREET
Second Line : SUITE 308
City : WILLIAMSVILLE
State : NY
Zip : 14221-6737
Country : US
Telephone Number : 716-634-1184
Fax Number : 716-634-1184
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2006
Last Update Date : 05/22/2014

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