Provider Demographics
NPI:1598414724
Name:MIKOLAZYK, JOLEENA (LICSW)
Entity Type:Individual
Prefix:
First Name:JOLEENA
Middle Name:
Last Name:MIKOLAZYK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 GIFFORD ST UNIT 11
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2918
Mailing Address - Country:US
Mailing Address - Phone:617-283-6485
Mailing Address - Fax:
Practice Address - Street 1:350 GIFFORD ST UNIT 11
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2918
Practice Address - Country:US
Practice Address - Phone:617-283-6485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health