Provider Demographics
NPI:1609017839
Name:SZYDLOWSKI, MARY JANE (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:SZYDLOWSKI
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 ROBIE ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2621
Mailing Address - Country:US
Mailing Address - Phone:716-697-2957
Mailing Address - Fax:
Practice Address - Street 1:1590 HERTEL AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2904
Practice Address - Country:US
Practice Address - Phone:716-697-2957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health