| NPI | 1962388231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MAY RUSSELL Licensed Clinical Social Worker 716-479-7817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2025-08-13 |
| Last Update Date | 2025-08-13 |