Healthcare Provider Details

I. General information

NPI: 1659705887
Provider Name (Legal Business Name): NICOLE HYNES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 BROADWAY ST
BUFFALO NY
14212-1845
US

IV. Provider business mailing address

1412 SWEET HOME RD STE 3-5
AMHERST NY
14228-2795
US

V. Phone/Fax

Practice location:
  • Phone: 716-422-2002
  • Fax: 716-893-0128
Mailing address:
  • Phone: 716-422-2002
  • Fax: 716-893-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006183-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: