Provider Demographics
NPI:1982274486
Name:HOWARD, MIA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIA
Middle Name:S
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:S
Other - Last Name:AHNTHOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED
Mailing Address - Street 1:35 PINE HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1012
Mailing Address - Country:US
Mailing Address - Phone:347-439-8414
Mailing Address - Fax:
Practice Address - Street 1:121 CEDAR LANE
Practice Address - Street 2:SUITE 3A
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:347-439-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079317-01104100000X
NJ44SL05543800104100000X
NJ44SC061512001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker