Provider Demographics
NPI:1184747909
Name:MIKELBERG, JULIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MIKELBERG
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 GOLF COURSE DR
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1415
Mailing Address - Country:US
Mailing Address - Phone:201-446-6068
Mailing Address - Fax:
Practice Address - Street 1:558 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1704
Practice Address - Country:US
Practice Address - Phone:201-943-2726
Practice Address - Fax:201-944-9619
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00012500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health