Provider Demographics
NPI:1649944638
Name:MEKUS, NICHOLAS THOMAS (LMSW)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:THOMAS
Last Name:MEKUS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH COLLINS
Mailing Address - State:NY
Mailing Address - Zip Code:14111-9701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2101 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:NORTH COLLINS
Practice Address - State:NY
Practice Address - Zip Code:14111-9701
Practice Address - Country:US
Practice Address - Phone:716-337-3706
Practice Address - Fax:716-337-2723
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113543104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker