Provider Demographics
NPI:1043255417
Name:VON WRYEZA-RAS, TAMMI LYNN (MSEDC, LMHC)
Entity type:Individual
Prefix:
First Name:TAMMI
Middle Name:LYNN
Last Name:VON WRYEZA-RAS
Suffix:
Gender:F
Credentials:MSEDC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 GRAND ISLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1693
Mailing Address - Country:US
Mailing Address - Phone:716-775-7566
Mailing Address - Fax:
Practice Address - Street 1:2680 GRAND ISLAND BLVD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1693
Practice Address - Country:US
Practice Address - Phone:716-775-7566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00030241501OtherUNIVERA
NY000506354003OtherCOMMUNITY BLUE