Individual
MS. CARLY JEAN HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
1131 BROADWAY ST, BUFFALO, NY 14212-1501
(716) 895-6700
(716) 896-7717
Mailing address
1131 BROADWAY ST, BUFFALO, NY 14212-1501
(716) 895-6700
(716) 896-7717
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/05/2019
Last updated
09/05/2019
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