Healthcare Provider Details

I. General information

NPI: 1154256550
Provider Name (Legal Business Name): NICHOLAS SUMMERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PILLING ST
BROOKLYN NY
11207-1610
US

IV. Provider business mailing address

1358 HANCOCK ST APT 3R
BROOKLYN NY
11237-6126
US

V. Phone/Fax

Practice location:
  • Phone: 718-602-1000
  • Fax:
Mailing address:
  • Phone: 518-894-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: