Individual
MR. COLEMAN PETTWAY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
89 BUTLER AVE, BUFFALO, NY 14208-1517
(516) 592-8452
Mailing address
PO BOX 641, BUFFALO, NY 14215-0641
(516) 592-8452
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
094503
NY
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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