Provider Demographics
NPI:1992060024
Name:MARGOLIN, MILENA V (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MILENA
Middle Name:V
Last Name:MARGOLIN
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 1:6822 LORETTO AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-4543
Mailing Address - Country:US
Mailing Address - Phone:610-716-7617
Mailing Address - Fax:215-535-3711
Practice Address - Street 1:6822 LORETTO AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-4543
Practice Address - Country:US
Practice Address - Phone:610-716-7617
Practice Address - Fax:215-535-3711
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-04
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05682300104100000X
PACW0172581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker