Provider Demographics
NPI:1376558098
Name:MIKSINSKI, THADDEUS ANTHONY III (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:THADDEUS
Middle Name:ANTHONY
Last Name:MIKSINSKI
Suffix:III
Gender:M
Credentials:LCSW-C
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Mailing Address - Street 1:2406 FOREST EDGE CT
Mailing Address - Street 2:#103 L
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2833
Mailing Address - Country:US
Mailing Address - Phone:410-695-0353
Mailing Address - Fax:
Practice Address - Street 1:650 RITCHIE HWY
Practice Address - Street 2:SUITE 207
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3916
Practice Address - Country:US
Practice Address - Phone:410-315-9350
Practice Address - Fax:410-315-9353
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD118051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical