Provider Demographics
NPI:1356783575
Name:MIKALONIS, ESTANISLAO ANTONIO (MFT)
Entity type:Individual
Prefix:
First Name:ESTANISLAO
Middle Name:ANTONIO
Last Name:MIKALONIS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 EMILY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-2022
Mailing Address - Country:US
Mailing Address - Phone:650-224-2017
Mailing Address - Fax:
Practice Address - Street 1:810 EMILY DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-2022
Practice Address - Country:US
Practice Address - Phone:650-224-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist