Healthcare Provider Details

I. General information

NPI: 1265248843
Provider Name (Legal Business Name): MIKELLY CECILE ARTILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 E 21ST ST
BROOKLYN NY
11210-5037
US

IV. Provider business mailing address

194 DAVIS AVE APT 55
KEARNY NJ
07032-3455
US

V. Phone/Fax

Practice location:
  • Phone: 732-337-6443
  • Fax:
Mailing address:
  • Phone: 347-358-0646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: