Provider Demographics
NPI:1922536655
Name:CENTER, MIKAELA JACKLIN
Entity Type:Individual
Prefix:MRS
First Name:MIKAELA
Middle Name:JACKLIN
Last Name:CENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MIKAELA
Other - Middle Name:JACKLIN
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:50 BEAVER ST STE 301
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-1504
Mailing Address - Country:US
Mailing Address - Phone:518-669-4227
Mailing Address - Fax:
Practice Address - Street 1:50 BEAVER ST STE 301
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-1504
Practice Address - Country:US
Practice Address - Phone:518-669-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY093750-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health