Provider Demographics
NPI:1821638891
Name:NYACHAE, NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:NYACHAE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-3741
Mailing Address - Country:US
Mailing Address - Phone:585-355-8805
Mailing Address - Fax:
Practice Address - Street 1:3300 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-3741
Practice Address - Country:US
Practice Address - Phone:585-865-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2025-03-10
Deactivation Date:2024-08-19
Deactivation Code:
Reactivation Date:2024-08-26
Provider Licenses
StateLicense IDTaxonomies
NY0976201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical