Provider Demographics
NPI:1932283595
Name:MOSER, SARA BETH (MS)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:BETH
Last Name:MOSER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:BETH
Other - Last Name:BUKKOSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:140 KNOWLTON AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2812
Mailing Address - Country:US
Mailing Address - Phone:716-881-2591
Mailing Address - Fax:716-881-0652
Practice Address - Street 1:923 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1121
Practice Address - Country:US
Practice Address - Phone:716-881-2591
Practice Address - Fax:716-881-0652
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health