Provider Demographics
NPI:1629520390
Name:MIKEL, EMERY (ATR-BC, LCAT, LPAT)
Entity Type:Individual
Prefix:MS
First Name:EMERY
Middle Name:
Last Name:MIKEL
Suffix:
Gender:F
Credentials:ATR-BC, LCAT, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 E 5TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4085
Mailing Address - Country:US
Mailing Address - Phone:703-402-4515
Mailing Address - Fax:
Practice Address - Street 1:444 E 5TH ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4085
Practice Address - Country:US
Practice Address - Phone:703-402-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ16LP00020400221700000X
NY001547221700000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor