Provider Demographics
NPI:1003509449
Name:VILLAGE PSYCHOLOGY GROUP, PLLC
Entity Type:Organization
Organization Name:VILLAGE PSYCHOLOGY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KAMPER
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:716-341-4740
Mailing Address - Street 1:2969 MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1066
Mailing Address - Country:US
Mailing Address - Phone:716-341-4740
Mailing Address - Fax:
Practice Address - Street 1:2969 MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1066
Practice Address - Country:US
Practice Address - Phone:716-341-4740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty