Individual
MR. DENNIS MIKKELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
601 BROADWAY, BAYONNE, NJ 07002-3818
(201) 339-9200
Mailing address
38 ROLLING HILL RD, CLINTON, NJ 08809-2617
(201) 725-8022
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC04809100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0021806
—
NJ
Enumeration date
01/17/2007
Last updated
11/16/2011
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