Provider Demographics
NPI:1740508688
Name:SZUBIAK, NICHOLAS (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:SZUBIAK
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68-1125 N KANIKU DR
Mailing Address - Street 2:APT 1106
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7722
Mailing Address - Country:US
Mailing Address - Phone:808-895-7679
Mailing Address - Fax:
Practice Address - Street 1:64-1035 MAMALAHO HWY
Practice Address - Street 2:SUITE O
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8440
Practice Address - Country:US
Practice Address - Phone:808-895-7679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-15
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI36371041C0700X
NY73-0699521041C0700X
AZ118921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical