Provider Demographics
NPI:1639314214
Name:BUWELL, VIRGINIA ANN (MHC MSED)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ANN
Last Name:BUWELL
Suffix:
Gender:F
Credentials:MHC MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 EMERSON RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-4318
Mailing Address - Country:US
Mailing Address - Phone:315-386-3488
Mailing Address - Fax:315-386-3762
Practice Address - Street 1:188 EMERSON RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-4318
Practice Address - Country:US
Practice Address - Phone:315-386-3488
Practice Address - Fax:315-386-3762
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health