Provider Demographics
NPI:1609345230
Name:KERN, ELIZABETH ANN (101YM0800X)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:KERN
Suffix:
Gender:F
Credentials:101YM0800X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 LAMARCK DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4854
Mailing Address - Country:US
Mailing Address - Phone:716-208-7159
Mailing Address - Fax:
Practice Address - Street 1:646 N FRENCH RD STE 7
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14228-2100
Practice Address - Country:US
Practice Address - Phone:716-616-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
010696101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health