Provider Demographics
NPI:1417224346
Name:EATON-WOLKIEWICZ, NICHOL A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICHOL
Middle Name:A
Last Name:EATON-WOLKIEWICZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NICHOL
Other - Middle Name:A
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6556 EAST QUAKER
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-539-9232
Mailing Address - Fax:716-539-9230
Practice Address - Street 1:6556 EAST QUAKER
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-539-9232
Practice Address - Fax:716-539-9230
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68 019398103T00000X
NY019398-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist