Individual
JEANNINE MICKULAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
43 ARISTA DR, DIX HILLS, NY 11746-4920
(631) 683-4393
Mailing address
43 ARISTA DR, DIX HILLS, NY 11746-4920
(631) 683-4393
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/25/2014
Last updated
02/21/2024
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