Provider Demographics
NPI:1922166156
Name:MIKKELSEN, MARILYN RUTH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:RUTH
Last Name:MIKKELSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AGAPE
Other - Middle Name:COUNSELING
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3349 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-9000
Mailing Address - Country:US
Mailing Address - Phone:954-649-0057
Mailing Address - Fax:954-578-5862
Practice Address - Street 1:3349 N UNIVERSITY DR
Practice Address - Street 2:SUITE 4
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-9000
Practice Address - Country:US
Practice Address - Phone:954-649-0057
Practice Address - Fax:954-578-5862
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW48421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical