Provider Demographics
NPI:1942037429
Name:LEMUS, NICHOLAS JUAN (MHC-LP)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JUAN
Last Name:LEMUS
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HUNTER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6655
Mailing Address - Country:US
Mailing Address - Phone:845-217-7259
Mailing Address - Fax:
Practice Address - Street 1:15 LUCAS AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-863-4588
Practice Address - Fax:845-205-4323
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP118328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health