Provider Demographics
NPI:1851617849
Name:PIECZONKA, TIMOTHY M (MA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:PIECZONKA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 N FRENCH RD STE 7
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1900
Mailing Address - Country:US
Mailing Address - Phone:716-278-4594
Mailing Address - Fax:
Practice Address - Street 1:636 N FRENCH RD STE 7
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1900
Practice Address - Country:US
Practice Address - Phone:716-278-4594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health