Provider Demographics
NPI:1114576287
Name:DOUGLAS, MIKO E
Entity type:Individual
Prefix:MS
First Name:MIKO
Middle Name:E
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
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 1701
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-0075
Mailing Address - Country:US
Mailing Address - Phone:914-384-9852
Mailing Address - Fax:
Practice Address - Street 1:61 GRAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3599
Practice Address - Country:US
Practice Address - Phone:201-541-8600
Practice Address - Fax:201-541-8100
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical