Provider Demographics
NPI:1760424998
Name:WELIKSON, MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:WELIKSON
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 1:3299 CAMBRIDGE AVE
Mailing Address - Street 2:APT 8-D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3623
Mailing Address - Country:US
Mailing Address - Phone:917-715-9061
Mailing Address - Fax:917-796-4609
Practice Address - Street 1:3299 CAMBRIDGE AVE
Practice Address - Street 2:APT 8-D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3623
Practice Address - Country:US
Practice Address - Phone:917-715-9061
Practice Address - Fax:917-796-4609
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO219651101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN0L871Medicare ID - Type Unspecified