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NPI Code Detail

MEDICARE: MRS. MARILYN RUTH MIKKELSEN LCSW

MEDICARE: MRS. MARILYN RUTH MIKKELSEN 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
11041C0700XClinical Social WorkerSW4842FL

General Provider Information

NPI Number : 1922166156
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARILYN RUTH MIKKELSEN LCSW
Provider Business Mailing Address
First Line : 3349 N UNIVERSITY DR
Second Line : SUITE 4
City : HOLLYWOOD
State : FL
Zip : 33024-9000
Country : US
Telephone Number : 954-649-0057
Fax Number : 954-578-5862
Provider Business Practice Location Address
First Line : 3349 N UNIVERSITY DR
Second Line : SUITE 4
City : HOLLYWOOD
State : FL
Zip : 33024-9000
Country : US
Telephone Number : 954-649-0057
Fax Number : 954-578-5862
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/08/2007

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