Basic Information
| Provider Information | |||||||||
| NPI: | 1598861221 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOSTELNY | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | WEPPNER | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3821 TEACHERS LN APT 10 | ||||||||
| Address2: | |||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141272184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166045596 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3020 BAILEY AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142152814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168311800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| 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 | 1041C0700X | 000212-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.