Individual
CECILIA MIKALAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
57 CEDAR ST, WORCESTER, MA 01609-2183
(508) 752-7529
Mailing address
57 CEDAR ST, WORCESTER, MA 01609-2183
(508) 752-7529
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
57280
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3046770
—
MA
01
—
MIJ08334
BLUE CROSS
—
Enumeration date
08/03/2005
Last updated
07/08/2007
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