Organization
ACADEMIC HEALTH PSYCHOLOGY ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY MARK LACKNER PSY.D. (OWNER)
(716) 898-5671
Entity
Organization
Contact information
Practice address
462 GRIDER ST, ROOM G208, BUFFALO, NY 14215-3021
(716) 898-5671
(716) 898-3040
Mailing address
PO BOX 93, AMHERST, NY 14226-0093
(716) 898-5671
(716) 898-3040
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
012051-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025302101
UNIVERA ID NUMBER
NY
01
—
000523299002
BLUE CROSS ID NUMBER
NY
01
—
6108856
IHA ID NUMBER
NY
01
—
DF1724
RR MEDICARE
NY
Enumeration date
03/12/2007
Last updated
08/22/2020
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