Provider Demographics
NPI:1275276719
Name:PRIEST, NIKOLAS FOREST
Entity type:Individual
Prefix:MR
First Name:NIKOLAS
Middle Name:FOREST
Last Name:PRIEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 VETERAN AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4819
Mailing Address - Country:US
Mailing Address - Phone:917-817-8609
Mailing Address - Fax:
Practice Address - Street 1:240 E 38TH ST FL 15
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2708
Practice Address - Country:US
Practice Address - Phone:212-263-6156
Practice Address - Fax:212-263-2683
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
NY103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist