Provider Demographics
NPI:1053724260
Name:CORNELIUS, ERIN (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:CORNELIUS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-0180
Mailing Address - Country:US
Mailing Address - Phone:617-501-6135
Mailing Address - Fax:
Practice Address - Street 1:70 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2308
Practice Address - Country:US
Practice Address - Phone:716-675-9232
Practice Address - Fax:716-675-9217
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020476103TC1900X
PATPS030225103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist