Organization
CHILD AND FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELAINE KOEPPEL LCSW R (MENTAL HEALTH CLINICIAN)
(716) 842-2750
Entity
Organization
Contact information
Practice address
330 DELAWARE AVE, BUFFALO, NY 14202-1804
(716) 842-2750
Mailing address
330 DELAWARE AVE, BUFFALO, NY 14202-1804
(716) 842-2750
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1041C0700X
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00031940
—
NY
01
—
000526549001
BLUE CROSS/BLUE SHIELD
NY
Enumeration date
11/01/2006
Last updated
08/22/2020
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