Provider Demographics
NPI:1356977151
Name:ANNIE COBURN KANE, LCSW PC
Entity type:Organization
Organization Name:ANNIE COBURN KANE, LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COBURN-KANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:716-807-2582
Mailing Address - Street 1:638 LAKE ST # 818
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NY
Mailing Address - Zip Code:14172-9600
Mailing Address - Country:US
Mailing Address - Phone:716-807-2582
Mailing Address - Fax:
Practice Address - Street 1:638 LAKE ST # 818
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NY
Practice Address - Zip Code:14172-9600
Practice Address - Country:US
Practice Address - Phone:716-807-2582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty