Provider Demographics
NPI:1043351190
Name:JUNGELS, GEORGIANA HAUMANN (MA, ATR-BC, LCAT)
Entity Type:Individual
Prefix:PROF
First Name:GEORGIANA
Middle Name:HAUMANN
Last Name:JUNGELS
Suffix:
Gender:F
Credentials:MA, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 W DELAVAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1220
Mailing Address - Country:US
Mailing Address - Phone:716-886-2083
Mailing Address - Fax:716-886-2083
Practice Address - Street 1:1914 COLVIN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-6973
Practice Address - Country:US
Practice Address - Phone:716-837-8333
Practice Address - Fax:716-837-3050
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000765221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist