Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor |
NPI | 1003278649 |
---|---|
Provider Name | Thomas Edward Livernois |
First Address | Buffalo, NY 14226-1813 |
Second Address | Buffalo, NY 14226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 21/08/2018 |