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Individual

AUTUMN TOWER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
589 LOCUST ST, LOCKPORT, NY 14094-5602
(302) 344-1622
Mailing address
589 LOCUST ST, LOCKPORT, NY 14094-5602

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
119841
NY

Other

Enumeration date
06/07/2023
Last updated
06/07/2023
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