Healthcare Provider Details

I. General information

NPI: 1053473744
Provider Name (Legal Business Name): PAUL NYKLICEK LMFT, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 FARMINGTON AVE BUILDING 4A
FARMINGTON CT
06032-2300
US

IV. Provider business mailing address

20 ARIEL WAY
AVON CT
06001-3701
US

V. Phone/Fax

Practice location:
  • Phone: 860-573-3650
  • Fax:
Mailing address:
  • Phone: 860-573-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000240
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000804
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: