Provider Demographics
NPI:1992852420
Name:MILLIKEN, PATRICIA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S 4TH ST
Mailing Address - Street 2:SUITE 592
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1570
Mailing Address - Country:US
Mailing Address - Phone:215-925-1622
Mailing Address - Fax:215-334-4441
Practice Address - Street 1:525 S 4TH ST
Practice Address - Street 2:SUITE 592
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1570
Practice Address - Country:US
Practice Address - Phone:215-925-1622
Practice Address - Fax:215-334-4441
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0131201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07825088Medicaid
PA0893989000OtherPERSONAL CHOICE
PA4653065OtherAETNA
PA07825088Medicaid