| Doctor Name: | MR. NICHOLAS S. KOUMOS |
| NPI Number: | 1831414283 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 001125 |
| Business Practice Address: | 8808 Rockaway Beach Blvd Rockaway Beach, NY - 116931608 |
| Business Phone Number: | 7186348922 |
| Business Fax Number: | 7186345740 |
| Mailing Address: | 69 Park Ave, MALVERNE |
| State: | NY |
| Postal Code: | 115651916 |
| Phone Number: | 5165960452 |
| Fax Number: | |
| NPI Enumeration Date: | 03/29/2010 |
| NPI Last Update Date: | 01/14/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 001125 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |