Provider Demographics
NPI:1316313265
Name:BUFFALO BEHAVIORAL PSYCHOLOGY, PC
Entity type:Organization
Organization Name:BUFFALO BEHAVIORAL PSYCHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:716-634-0627
Mailing Address - Street 1:2813 WEHRLE DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7384
Mailing Address - Country:US
Mailing Address - Phone:716-634-0627
Mailing Address - Fax:716-634-0746
Practice Address - Street 1:2813 WEHRLE DR
Practice Address - Street 2:SUITE 11
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7384
Practice Address - Country:US
Practice Address - Phone:716-634-0627
Practice Address - Fax:716-634-0746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68 018671103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty