Provider Demographics
NPI:1386879864
Name:CRANS-STAFFORD, AMY JO (PHD)
Entity type:Individual
Prefix:
First Name:AMY JO
Middle Name:
Last Name:CRANS-STAFFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8169
Mailing Address - Country:US
Mailing Address - Phone:716-836-9460
Mailing Address - Fax:716-836-9462
Practice Address - Street 1:884 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-8169
Practice Address - Country:US
Practice Address - Phone:716-836-9460
Practice Address - Fax:716-836-9462
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018079-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical