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General NPI Number Information
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NPI Number | 1407705973
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Entity Type | Individual
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Provider Name | NICKOLAS MANDZIARA TLLP
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Gender | Male
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 1135 W UNIVERSITY DR STE 445
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-1897
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Country | US
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Telephone | 248-413-5027
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Fax |
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Provider Business Mailing Address
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Address Line | 18911 WALDEN ST APT 201
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-2332
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6362010107
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License Number State | MI
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