Basic Information
| Provider Information | |||||||||
| NPI: | 1366553018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WENNER | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3110 TONAWANDA CREEK RD | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142281503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164742159 | ||||||||
| FaxNumber: | 7168344557 | ||||||||
| Practice Location | |||||||||
| Address1: | 3297 BAILEY AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142151139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168333622 | ||||||||
| FaxNumber: | 7168344557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| 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 | 101YM0800X | 001925-1 | NY | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 002510 | MO | X | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.