| NPI | 1013049279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MARK LACKNER Owner 716-898-5671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 012051-1) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2020-08-22 |