Provider Demographics
NPI:1144438045
Name:GANOUDIS, NICHOLAS KIM (LCSW-R, LP)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:KIM
Last Name:GANOUDIS
Suffix:
Gender:M
Credentials:LCSW-R, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W 23RD ST APT 1EE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1409
Mailing Address - Country:US
Mailing Address - Phone:718-530-4446
Mailing Address - Fax:
Practice Address - Street 1:415 W 23RD ST APT 1EE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1409
Practice Address - Country:US
Practice Address - Phone:718-530-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0756651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical