MEDICARE: MS. MARISA K. MICKEL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	086063	NY
2	1041C0700X	Clinical Social Worker	16689	CT

General Provider Information

NPI Number	:	1184971566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARISA K. MICKEL LCSW

Provider Business Mailing Address
First Line	:	125 LANE GATE RD
Second Line	:
City	:	COLD SPRING
State	:	NY
Zip	:	10516-3522
Country	:	US
Telephone Number	:	646-504-5254
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 5TH AVE RM 903
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-7611
Country	:	US
Telephone Number	:	212-633-9162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	04/15/2026

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