Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 018463 | NY |
Y | 103TC0700X | Clinical Psychologist | 018463 | NY |
NPI | 1003034992 |
---|---|
Provider Name | Peter Alex Cogswell |
First Address | Buffalo, NY 14202 |
Second Address | Buffalo, NY 14202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 12/03/2019 |