Provider Demographics
NPI:1053779843
Name:MARTIN, RIANNON
Entity type:Individual
Prefix:
First Name:RIANNON
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RIANNON
Other - Middle Name:
Other - Last Name:BANAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:227 THORN AVENUE SPECTRUM HEALTH & HUMAN SERVICES
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-662-2040
Mailing Address - Fax:716-662-0019
Practice Address - Street 1:2040 SENECA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2324
Practice Address - Country:US
Practice Address - Phone:716-828-0560
Practice Address - Fax:716-828-1522
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health