Provider Demographics
NPI:1346489135
Name:DOMBROWSKI, FREDRICK B (MA, LMHC, CASAC-T)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:B
Last Name:DOMBROWSKI
Suffix:
Gender:M
Credentials:MA, LMHC, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 BAILEY AVE
Mailing Address - Street 2:3927 BAILEY AVE.
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2814
Mailing Address - Country:US
Mailing Address - Phone:716-833-3622
Mailing Address - Fax:
Practice Address - Street 1:3297 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1139
Practice Address - Country:US
Practice Address - Phone:716-833-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health