Provider Demographics
NPI:1790803922
Name:BUCK, MIKHEL CHARLES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MIKHEL
Middle Name:CHARLES
Last Name:BUCK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 NORTHEAST 114 STREET
Mailing Address - Street 2:801
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3417
Mailing Address - Country:US
Mailing Address - Phone:305-891-1067
Mailing Address - Fax:305-891-1067
Practice Address - Street 1:1800 NORTHEAST 114 STREET
Practice Address - Street 2:801
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3417
Practice Address - Country:US
Practice Address - Phone:305-891-1067
Practice Address - Fax:305-891-1067
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0002763103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist