MEDICARE: DR. NICHOLAS HOLUB PSYD, MSW

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	025522-01	NY
2	103TC2200X	Clinical Child & Adolescent Psychologist	025522-01	NY
3	103TF0200X	Forensic Psychologist	025522-01	NY
4	103TC0700X	Clinical Psychologist	025522-01	NY
5	103TM1800X	Intellectual & Developmental Disabilities Psychologist	025522-01	NY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1164620225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS HOLUB PSYD, MSW

Provider Business Mailing Address
First Line	:	30 OFFICE PARK WAY STE 1
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-1734
Country	:	US
Telephone Number	:	585-673-2002
Fax Number	:	585-203-1927

Provider Business Practice Location Address
First Line	:	30 OFFICE PARK WAY STE 1
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-1734
Country	:	US
Telephone Number	:	585-673-2002
Fax Number	:	585-203-1927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	10/06/2025

30 OFFICE PARK WAY , TOBEY VILLAGE OFFICE PARK
PITTSFORD, NY
14534-1734

Practice Phone: 585-348-9132
Practice Fax: