Organization
BHCOFWNY
Active
Other names
BHCofWNY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES JACK PHD (OWNER/SOLE PROPRIETOR)
(716) 598-8827
Entity
Organization
Contact information
Practice address
5178 PARKER RD, HAMBURG, NY 14075-1633
(716) 598-8827
Mailing address
5178 PARKER RD, HAMBURG, NY 14075-1633
(716) 598-8827
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
08/26/2022
Last updated
08/26/2022
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