Provider Demographics
NPI:1821307802
Name:THOMAS, NICHOLETTE K (MS, CRC)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLETTE
Middle Name:K
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, CRC
Other - Prefix:MISS
Other - First Name:NICHOLETTE
Other - Middle Name:K
Other - Last Name:POKRYWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3020 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 E AMHERST ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1804
Practice Address - Country:US
Practice Address - Phone:716-834-6401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY00112745101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)