Provider Demographics
NPI:1326100488
Name:MILCH, MITCHELL HOWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:HOWARD
Last Name:MILCH
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 1:100 DAYTON ST FL 1
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4437
Mailing Address - Country:US
Mailing Address - Phone:201-647-6607
Mailing Address - Fax:
Practice Address - Street 1:16-53 CHANDLER DR
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2710
Practice Address - Country:US
Practice Address - Phone:201-773-8650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC 440771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ634285Medicare ID - Type Unspecified