Provider Demographics
NPI:1386956050
Name:ORR, JUSTIN CHARLES (BA)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:CHARLES
Last Name:ORR
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1503
Mailing Address - Country:US
Mailing Address - Phone:716-882-5959
Mailing Address - Fax:716-884-0602
Practice Address - Street 1:1300 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1503
Practice Address - Country:US
Practice Address - Phone:716-882-5959
Practice Address - Fax:716-884-0602
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16-1037485Medicaid