MEDICARE: KATHLEEN CRISSEY

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	001479	NY

General Provider Information

NPI Number	:	1689829780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN CRISSEY

Provider Business Mailing Address
First Line	:	153 W UTICA ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14222-2017
Country	:	US
Telephone Number	:	716-884-7569
Fax Number	:

Provider Business Practice Location Address
First Line	:	2805 WEHRLE DR STE 1
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-7383
Country	:	US
Telephone Number	:	716-807-9494
Fax Number	:

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

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	03/25/2024

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Directions to “ KATHLEEN CRISSEY ” Practice Location

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