Provider Demographics
NPI:1548772312
Name:LORI BADACH,LCSW, PLLC
Entity Type:Organization
Organization Name:LORI BADACH,LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BADACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:716-331-0447
Mailing Address - Street 1:59 WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-4327
Mailing Address - Country:US
Mailing Address - Phone:716-308-7056
Mailing Address - Fax:
Practice Address - Street 1:2240 NORTH FOREST ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1422
Practice Address - Country:US
Practice Address - Phone:716-331-0447
Practice Address - Fax:716-331-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR071801-01251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225454572OtherINDIVIDUAL NPI