Provider Demographics
NPI:1639985435
Name:INTEGRATIVE NP IN PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:INTEGRATIVE NP IN PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:716-578-5788
Mailing Address - Street 1:81 DARTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-3121
Mailing Address - Country:US
Mailing Address - Phone:716-578-5788
Mailing Address - Fax:
Practice Address - Street 1:5775 BROADWAY ST STE 14
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-2456
Practice Address - Country:US
Practice Address - Phone:716-578-5788
Practice Address - Fax:207-419-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty