Healthcare Provider Details

I. General information

NPI: 1649944638
Provider Name (Legal Business Name): NICHOLAS THOMAS MEKUS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 SPRUCE ST
NORTH COLLINS NY
14111-9701
US

IV. Provider business mailing address

2101 SPRUCE ST
NORTH COLLINS NY
14111-9701
US

V. Phone/Fax

Practice location:
  • Phone: 716-337-3706
  • Fax: 716-337-2723
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number113543
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: