Provider Demographics
NPI:1093894321
Name:MIKKOLA, MARGARETTE A (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARGARETTE
Middle Name:A
Last Name:MIKKOLA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARGARETTE
Other - Middle Name:
Other - Last Name:POSEVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:161 WASHINGTON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EAST WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02032-1196
Mailing Address - Country:US
Mailing Address - Phone:781-996-3668
Mailing Address - Fax:781-996-3668
Practice Address - Street 1:161 WASHINGTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:EAST WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02032-1196
Practice Address - Country:US
Practice Address - Phone:781-996-3668
Practice Address - Fax:781-996-3668
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1053841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P03583Medicare ID - Type Unspecified