Provider Demographics
NPI:1104967652
Name:MOXHAM, SUZANNE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LYNN
Last Name:MOXHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 BAILEY AVE - 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215
Mailing Address - Country:US
Mailing Address - Phone:716-831-1800
Mailing Address - Fax:716-842-1277
Practice Address - Street 1:6495 TRANSIT RD.
Practice Address - Street 2:SUITE 800
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051
Practice Address - Country:US
Practice Address - Phone:716-418-8531
Practice Address - Fax:716-418-8514
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074271-7104100000X
NY0790541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker