NPIMap

Organization Active NPI

Academic Health Psychology Associates, P.C.

  • Cognitive & Behavioral Psychologist
  • Buffalo, NY
National Provider Identifier
1013049279
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
License
012051-1 Issued in NY
Legal business name
ACADEMIC HEALTH PSYCHOLOGY ASSOCIATES, P.C.
Practice address
462 Grider St
Room G208
Buffalo, NY 14215-3021
Phone
(716) 898-5671
Fax
(716) 898-3040
NPI assigned
Mar 12, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey Mark Lackner, PSY.D.NPI 1821293168
Title
Owner
Phone
(716) 898-5671

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X 012051-1 NY Primary

Addresses

Primary practice location

462 Grider St
Room G208
Buffalo, NY 14215-3021

Mailing address

PO Box 93
Amherst, NY 14226-0093
Phone (716) 898-5671

Other identifiers 4

IdentifierTypeStateIssuer
000523299002OtherNYBLUE CROSS ID NUMBER
00025302101OtherNYUNIVERA ID NUMBER
6108856OtherNYIHA ID NUMBER
DF1724OtherNYRR MEDICARE

National Provider Directory

National Provider Directory

Locations

462 Grider St
Rm G208
Buffalo, NY 14215
Phone (716) 898-5671

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013049279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 93",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142260093",
            "telephone_number": "716-898-5671",
            "fax_number": "716-898-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "462 GRIDER ST",
            "address_2": "ROOM G208",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142153021",
            "telephone_number": "716-898-5671",
            "fax_number": "716-898-3040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADEMIC HEALTH PSYCHOLOGY ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LACKNER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-898-5671",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NY",
            "license": "012051-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID NUMBER",
            "identifier": "000523299002",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA ID NUMBER",
            "identifier": "00025302101",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHA ID NUMBER",
            "identifier": "6108856",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DF1724",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.