Basic Information
| Provider Information | |||||||||
| NPI: | 1346489135 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOMBROWSKI | ||||||||
| FirstName: | FREDRICK | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MA, LMHC, CASAC-T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3020 BAILEY AVE | ||||||||
| Address2: | 3927 BAILEY AVE. | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142152814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168333622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3297 BAILEY AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142151139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168333622 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2009 | ||||||||
| LastUpdateDate: | 02/18/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 004214 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.