Provider Demographics
NPI:1083825681
Name:MIKOLAWSKI-AGUINAGA, GINA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:MIKOLAWSKI-AGUINAGA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102101
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2101
Mailing Address - Country:US
Mailing Address - Phone:863-603-6565
Mailing Address - Fax:863-603-6576
Practice Address - Street 1:500 S FLORIDA AVE
Practice Address - Street 2:# 210
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5276
Practice Address - Country:US
Practice Address - Phone:863-687-1222
Practice Address - Fax:863-603-6546
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW69781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1497748743OtherGROUP NPI NUMBER / LRHSI
FLDA5786OtherRAILROAD MEDICARE GROUP ID NUMBER / LRHSI
FLU1741Medicare UPIN