Basic Information
| Provider Information | |||||||||
| NPI: | 1437418696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOCKMASTER | ||||||||
| FirstName: | LAUREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3020 BAILEY AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142152814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168311800 | ||||||||
| FaxNumber: | 7168311818 | ||||||||
| Practice Location | |||||||||
| Address1: | 314 ELLICOTT ST | ||||||||
| Address2: | |||||||||
| City: | BATAVIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140203650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5858150247 | ||||||||
| FaxNumber: | 5858150251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2012 | ||||||||
| LastUpdateDate: | 05/09/2012 | ||||||||
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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 | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.