Provider Demographics
NPI:1124418306
Name:GATEWAY-LONGVIEW
Entity Type:Organization
Organization Name:GATEWAY-LONGVIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CARMELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFALINO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CAS
Authorized Official - Phone:716-783-3230
Mailing Address - Street 1:297 PARAMOUNT PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1074
Mailing Address - Country:US
Mailing Address - Phone:716-725-1630
Mailing Address - Fax:
Practice Address - Street 1:10 SYMPHONY CIR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1363
Practice Address - Country:US
Practice Address - Phone:716-783-3230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY867311141251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health