Basic Information
| Provider Information | |||||||||
| NPI: | 1639221666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 768 DELEWARE AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168813151 | ||||||||
| FaxNumber: | 7168812425 | ||||||||
| Practice Location | |||||||||
| Address1: | 3350 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168354011 | ||||||||
| FaxNumber: | 7168350253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0744071 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.