Provider Demographics
NPI:1053473744
Name:NYKLICEK, PAUL (LMFT, LADC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:NYKLICEK
Suffix:
Gender:M
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ARIEL WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3701
Mailing Address - Country:US
Mailing Address - Phone:860-573-3650
Mailing Address - Fax:
Practice Address - Street 1:790 FARMINGTON AVE
Practice Address - Street 2:BUILDING 4A
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2300
Practice Address - Country:US
Practice Address - Phone:860-573-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000240101YA0400X
CT000804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist