Provider Demographics
NPI:1477562429
Name:JANICKI, PAULA IRENE (PHD/)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:IRENE
Last Name:JANICKI
Suffix:
Gender:F
Credentials:PHD/
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MAIN STREET
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6737
Mailing Address - Country:US
Mailing Address - Phone:716-634-1184
Mailing Address - Fax:716-634-3207
Practice Address - Street 1:5500 MAIN STREET
Practice Address - Street 2:SUITE 308
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6737
Practice Address - Country:US
Practice Address - Phone:716-634-1184
Practice Address - Fax:716-634-1184
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013229-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist