Provider Demographics
NPI:1811072374
Name:MIHAYLO, LUKE GEORGE JR (LCSW LADC)
Entity type:Individual
Prefix:MR
First Name:LUKE
Middle Name:GEORGE
Last Name:MIHAYLO
Suffix:JR
Gender:M
Credentials:LCSW LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:82 WEWAKA BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:CT
Mailing Address - Zip Code:06752-1712
Mailing Address - Country:US
Mailing Address - Phone:860-355-2995
Mailing Address - Fax:860-355-4297
Practice Address - Street 1:82 WEWAKA BROOK RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:CT
Practice Address - Zip Code:06752-1712
Practice Address - Country:US
Practice Address - Phone:860-355-2995
Practice Address - Fax:860-355-4297
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT30000223CT01-LADC101YA0400X
CT140004395CT021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11467756OtherUNIVERSAL CREDENTIALING
CT140004395CT02OtherLICENSED CLINICAL SW
CT140004395CT02OtherANTHEM BLUE CROSS/BS
CT30000223CT01-LADCOtherLICENSED DRUG/ALCOHOL
CT30000223CT01-LADCOtherANTHEM BLUE CROSS/BS