Provider Demographics
NPI:1932234580
Name:MIKULKA, CHARLETTE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLETTE
Middle Name:
Last Name:MIKULKA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2037
Mailing Address - Country:US
Mailing Address - Phone:973-579-1710
Mailing Address - Fax:
Practice Address - Street 1:113 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2037
Practice Address - Country:US
Practice Address - Phone:973-579-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043360001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical