MEDICARE: NIKITA DOW COUNSELING AND CONSULTING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1295697597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIKITA DOW COUNSELING AND CONSULTING

Provider Business Mailing Address
First Line	:	119 N PARK AVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-7224
Country	:	US
Telephone Number	:	631-223-9665
Fax Number	:	631-223-9665

Provider Business Practice Location Address
First Line	:	119 N PARK AVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-7224
Country	:	US
Telephone Number	:	631-223-9665
Fax Number	:	631-223-9665

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	NIKITA DOW
Credential	:	LCSW
Telephone Number	:	631-223-9665

Provider Enumeration Date	:	11/25/2025
Last Update Date	:	11/25/2025

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