MEDICARE: ELIZABETH ANN KERN 101YM0800X

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	101YM0800X	Mental Health Counselor	010696
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1609345230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN KERN 101YM0800X

Provider Business Mailing Address
First Line	:	332 LAMARCK DR
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14226-4854
Country	:	US
Telephone Number	:	716-208-7159
Fax Number	:

Provider Business Practice Location Address
First Line	:	646 N FRENCH RD STE 7
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14228-2100
Country	:	US
Telephone Number	:	716-616-0014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2018
Last Update Date	:	05/24/2024

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