Individual
DEBORAH J MIKITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
3679 E STATE ST, HERMITAGE, PA 16148-3411
(724) 982-0414
(724) 982-4407
Mailing address
6802 TANGLEWOOD DRIVE, BOARDMAN, OH 44512
(330) 629-9893
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS8073L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000557345
HIGHMARK BCBS
PA
05
—
0016126440004
—
PA
Enumeration date
07/28/2006
Last updated
04/25/2011
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