Provider Demographics
NPI:1689234668
Name:KAZMARK, HEIDI LYNNE (CASAC-T)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNNE
Last Name:KAZMARK
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7919 MILL STREET
Mailing Address - Street 2:
Mailing Address - City:EAST OTTO
Mailing Address - State:NY
Mailing Address - Zip Code:14729
Mailing Address - Country:US
Mailing Address - Phone:716-244-1854
Mailing Address - Fax:716-242-1663
Practice Address - Street 1:36 THOMAS INDIAN SCHOOL DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9300
Practice Address - Country:US
Practice Address - Phone:716-532-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35657101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)