| Envision Wellness Wny Behavioral Health | |
|
2495 Elmwood Ave Kenmore NY 14217-2222 | |
| (716) 882-2127 | |
| (716) 882-9277 |
| Full Name | Envision Wellness Wny Behavioral Health |
|---|---|
| Speciality | Counselor |
| Location | 2495 Elmwood Ave, Kenmore, New York |
| Authorized Official Name and Position | Daniel Church (FINANCE DIRECTOR) |
| Authorized Official Contact | 7168822127 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Envision Wellness Wny Behavioral Health Po Box 710 Kenmore NY 14217-0710 Ph: (716) 882-2127 | Envision Wellness Wny Behavioral Health 2495 Elmwood Ave Kenmore NY 14217-2222 Ph: (716) 882-2127 |
| NPI Number | 1679698286 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 01/31/2022 |
| Certification Date | 01/31/2022 |
| Medicare PECOS PAC ID | 1658365101 |
|---|---|
| Medicare Enrollment ID | O20040408001227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679698286 | NPI | - | NPPES |
| 02996876 | Medicaid | NY | |
| 01556472 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Seth G Dewey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891757589 PECOS PAC ID: 7719945302 Enrollment ID: I20041230000064 |
| Provider Name | Diana J Page |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598896128 PECOS PAC ID: 5799822706 Enrollment ID: I20091023000523 |
| Provider Name | Lori A Haspett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639494388 PECOS PAC ID: 7911175641 Enrollment ID: I20110722000389 |
| Provider Name | Virginia Hogan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326253808 PECOS PAC ID: 9739266529 Enrollment ID: I20220930001587 |
| Provider Name | Lisa Hatrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972225282 PECOS PAC ID: 7517322399 Enrollment ID: I20230501000804 |
| Provider Name | Gena Marie Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083303846 PECOS PAC ID: 0840641163 Enrollment ID: I20240110003935 |
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