Basic Information
| Provider Information | |||||||||
| NPI: | 1265853949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIKOWSKI | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | LMSW-CC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 3RD ST APT 2 | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316455069 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40 SUMMER ST | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079454240 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2013 | ||||||||
| LastUpdateDate: | 12/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | MC14518 | ME | N | Agencies | Community/Behavioral Health | 253Z00000X | MC14518 | ME | Y | Agencies | In Home Supportive Care |
No ID Information.