Basic Information
| Provider Information | |||||||||
| NPI: | 1891986295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELZER | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 254 FRANKLIN ST | ||||||||
| Address2: | LAKE SHORE BEHAVIORAL HEALTH | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142021954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168420440 | ||||||||
| FaxNumber: | 7168424069 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 S PARK AVE | ||||||||
| Address2: | PARKVIEW CENTER | ||||||||
| City: | LACKAWANNA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168222117 | ||||||||
| FaxNumber: | 7168228165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2007 | ||||||||
| LastUpdateDate: | 08/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225C00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor |
No ID Information.