MEDICARE: DR. SUSAN STARR KRASNER 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
1	103TC0700X	Clinical Psychologist	010762	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000511230001	OTHER	NY	BC/BS WNY
2	00020351401	OTHER	NY	UNIVERA
3	6190235	OTHER	NY	INDEPENDENT HEALTH

General Provider Information

NPI Number	:	1770675167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN STARR KRASNER PH.D.

Provider Business Mailing Address
First Line	:	6507 TRANSIT RD
Second Line	:	STE B
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1427
Country	:	US
Telephone Number	:	716-204-0100
Fax Number	:	716-204-2761

Provider Business Practice Location Address
First Line	:	6507 TRANSIT RD
Second Line	:	STE B
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1427
Country	:	US
Telephone Number	:	716-204-0100
Fax Number	:	716-204-2761

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	08/26/2022

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