Basic Information
| Provider Information | |||||||||
| NPI: | 1659705887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HYNES | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1412 SWEET HOME RD STE 3-5 | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142282795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164222002 | ||||||||
| FaxNumber: | 7168930128 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142121845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164222002 | ||||||||
| FaxNumber: | 7168930128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2013 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 101YM0800X | 006183-1 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.