MEDICARE: MS. NINA M. MAINES LCSW-R

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	R082036	NY

General Provider Information

NPI Number	:	1851352405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NINA M. MAINES LCSW-R

Provider Business Mailing Address
First Line	:	3376 NIAGARA FALLS BLVD STE 5
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-1396
Country	:	US
Telephone Number	:	716-778-4418
Fax Number	:	716-304-1430

Provider Business Practice Location Address
First Line	:	3376 NIAGARA FALLS BLVD STE 5
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-1396
Country	:	US
Telephone Number	:	716-778-4418
Fax Number	:	716-304-1430

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	01/22/2026

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