Provider Demographics
NPI:1194269191
Name:WHELAN, BRENDA (LMHC)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:WHELAN
Suffix:
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 1:625 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2040
Mailing Address - Country:US
Mailing Address - Phone:716-228-1057
Mailing Address - Fax:716-464-7075
Practice Address - Street 1:625 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2040
Practice Address - Country:US
Practice Address - Phone:716-228-1057
Practice Address - Fax:716-464-7075
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health