Basic Information
| Provider Information | |||||||||
| NPI: | 1104907047 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAREK | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 DELAWARE AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142021009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168823151 | ||||||||
| FaxNumber: | 7168864022 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 DELAWARE AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142021009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168823151 | ||||||||
| FaxNumber: | 7168864022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 05/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 004967-1 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.