Provider Demographics
NPI:1457706277
Name:SIEMATKOWSKI, ELIZABETH ANN I (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ANN
Last Name:SIEMATKOWSKI
Suffix:I
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 ELMWOOD AVE
Mailing Address - Street 2:APT. 11B
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1837
Mailing Address - Country:US
Mailing Address - Phone:315-854-0265
Mailing Address - Fax:
Practice Address - Street 1:597 ELMWOOD AVE
Practice Address - Street 2:APT. 11B
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1837
Practice Address - Country:US
Practice Address - Phone:315-854-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18006627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health