Provider Demographics
NPI:1659705887
Name:HYNES, NICOLE (LMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HYNES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 SWEET HOME RD STE 3-5
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2795
Mailing Address - Country:US
Mailing Address - Phone:716-422-2002
Mailing Address - Fax:716-893-0128
Practice Address - Street 1:1500 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-1845
Practice Address - Country:US
Practice Address - Phone:716-422-2002
Practice Address - Fax:716-893-0128
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY006183-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker