Provider Demographics
NPI:1417031196
Name:GOZDZIALSKI, ANITA EVA (LMHC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:EVA
Last Name:GOZDZIALSKI
Suffix:
Gender:F
Credentials:LMHC
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:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2814
Mailing Address - Country:US
Mailing Address - Phone:716-831-1800
Mailing Address - Fax:716-831-1818
Practice Address - Street 1:699 HERTEL AVE
Practice Address - Street 2:350
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-2341
Practice Address - Country:US
Practice Address - Phone:716-831-1977
Practice Address - Fax:716-831-1985
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0015051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical