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General NPI Number Information
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NPI Number | 1184971566
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Entity Type | Individual
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Provider Name | MS. MARISA K. MICKEL
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Gender | Female
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 06/14/2024
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Provider Practice Location Address
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Address Line | 80 5TH AVE RM 903
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City | NEW YORK
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State | NY
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Zip | 10011-7611
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Country | US
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Telephone | 212-633-9162
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 516
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City | GARRISON
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State | NY
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Zip | 10524-0516
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Country | US
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Telephone | 646-504-5254
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 086063
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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