Healthcare Provider Details

I. General information

NPI: 1902495534
Provider Name (Legal Business Name): MIKAYLA MORIN LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E 23RD ST STE 500-11
NEW YORK NY
10010-4511
US

IV. Provider business mailing address

74 DE SALES PL APT 2R
BROOKLYN NY
11207-1845
US

V. Phone/Fax

Practice location:
  • Phone: 917-476-0539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number002686
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberP108224
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: