Provider Demographics
NPI:1154733855
Name:MIKULKA, JOSEPH THOMAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:MIKULKA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 86TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3600
Mailing Address - Country:US
Mailing Address - Phone:646-450-3153
Mailing Address - Fax:
Practice Address - Street 1:521 W 239TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1205
Practice Address - Country:US
Practice Address - Phone:718-601-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084337-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical