Provider Demographics
NPI:1366805244
Name:KLOSSNER, MICHELLE K (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:K
Last Name:KLOSSNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:K
Other - Last Name:CAVAGNARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMSW
Mailing Address - Street 1:330 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1868
Mailing Address - Country:US
Mailing Address - Phone:716-842-2750
Mailing Address - Fax:
Practice Address - Street 1:330 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1868
Practice Address - Country:US
Practice Address - Phone:716-842-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 101YM0800X
CT103901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical