Healthcare Provider Details

I. General information

NPI: 1962921569
Provider Name (Legal Business Name): NICHOLAS BRANDON FIGUEROA LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9027 SUTPHIN BLVD STE 5
JAMAICA NY
11435-3648
US

IV. Provider business mailing address

9027 SUTPHIN BLVD STE 5
JAMAICA NY
11435-3648
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-8400
  • Fax:
Mailing address:
  • Phone: 718-526-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010429
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: