Provider Demographics
NPI:1205074481
Name:MIERLAK, VICTORIA (MA, LCAT, MT-BC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MIERLAK
Suffix:
Gender:F
Credentials:MA, LCAT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 CRESCENT ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3930
Mailing Address - Country:US
Mailing Address - Phone:516-521-1431
Mailing Address - Fax:
Practice Address - Street 1:3541 CRESCENT ST APT 3R
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3930
Practice Address - Country:US
Practice Address - Phone:516-521-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001174225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist