Healthcare Provider Details

I. General information

NPI: 1871771790
Provider Name (Legal Business Name): NICHOLE LEAHNA ADAMS PSY. D., ABPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICHOLE FLORES PSY.D., ABPP

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 JEFFERSON AVE LUTHERAN COUNSELING CENTER
MINEOLA NY
11501-2712
US

IV. Provider business mailing address

132 JEFFERSON AVE LUTHERAN COUNSELING CENTER
MINEOLA NY
11501-2712
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-0994
  • Fax: 516-868-0955
Mailing address:
  • Phone: 516-741-0994
  • Fax: 516-306-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number017512
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number017512
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number017512
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1760064
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: