Healthcare Provider Details

I. General information

NPI: 1871142760
Provider Name (Legal Business Name): NICHOLAS COULSON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 10/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 WALDEN AVE STE 400
CHEEKTOWAGA NY
14225-4985
US

IV. Provider business mailing address

3 DEER RDG
GETZVILLE NY
14068-1272
US

V. Phone/Fax

Practice location:
  • Phone: 716-865-6700
  • Fax: 716-895-0436
Mailing address:
  • Phone: 315-400-7693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101204-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: