Healthcare Provider Details

I. General information

NPI: 1245679786
Provider Name (Legal Business Name): NICKEEMA ERICA LYTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOYT ST
BROOKLYN NY
11201-5809
US

IV. Provider business mailing address

489 RUTLAND RD
BROOKLYN NY
11203-1606
US

V. Phone/Fax

Practice location:
  • Phone: 718-802-0666
  • Fax: 718-858-9493
Mailing address:
  • Phone: 718-866-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP88798
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: