Provider Demographics
NPI:1568460988
Name:BUFFALO PSYCHOLOGY GROUP
Entity Type:Organization
Organization Name:BUFFALO PSYCHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:P
Authorized Official - Last Name:UNGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:716-833-6084
Mailing Address - Street 1:290 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1905
Mailing Address - Country:US
Mailing Address - Phone:716-833-6084
Mailing Address - Fax:
Practice Address - Street 1:290 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1905
Practice Address - Country:US
Practice Address - Phone:716-833-6084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006789-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY081881Medicare ID - Type UnspecifiedGROUP MEDICARE ID NUMBER