Basic Information
| Provider Information | |||||||||
| NPI: | 1174679005 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRABOWSKI | ||||||||
| FirstName: | JO-ANNE | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168564494 | ||||||||
| FaxNumber: | 7168421277 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 COLUMBUS ST | ||||||||
| Address2: | |||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142271251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168942743 | ||||||||
| FaxNumber: | 7168966394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 103T00000X | 00012694 | NY | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 000360241501 | 01 | UNIVERA | OTHER |