Provider Demographics
NPI:1093159501
Name:MIKODA, THOMAS EUGENE (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EUGENE
Last Name:MIKODA
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2384 COLESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HARPURSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13787-1727
Mailing Address - Country:US
Mailing Address - Phone:607-693-3765
Mailing Address - Fax:
Practice Address - Street 1:2384 COLESVILLE RD
Practice Address - Street 2:
Practice Address - City:HARPURSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13787-1727
Practice Address - Country:US
Practice Address - Phone:607-693-3765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO75271-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical