Provider Demographics
NPI:1720525983
Name:THOMAS, MICAELA MARIE MERRILLS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICAELA
Middle Name:MARIE MERRILLS
Last Name:THOMAS
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 1:207 W GORE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1014
Mailing Address - Country:US
Mailing Address - Phone:321-841-8555
Mailing Address - Fax:321-841-2425
Practice Address - Street 1:207 W GORE ST STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1014
Practice Address - Country:US
Practice Address - Phone:321-841-8555
Practice Address - Fax:321-841-2425
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW90711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100275300Medicaid