Provider Demographics
NPI:1306558978
Name:MIKULSKA, MARTA (LPC, NCC)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:MIKULSKA
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2815
Mailing Address - Country:US
Mailing Address - Phone:215-510-5611
Mailing Address - Fax:
Practice Address - Street 1:270 LANCASTER AVE BLDG J
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1858
Practice Address - Country:US
Practice Address - Phone:484-947-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015376101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health