Basic Information
| Provider Information | |||||||||
| NPI: | 1619424389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIELCAREK | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN, LSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MIELCAREK | ||||||||
| OtherFirstName: | JOSH | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | LPN, LSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1832 ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436044428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197209247 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1832 ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436044428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197209247 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2016 | ||||||||
| LastUpdateDate: | 09/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1501249 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | 164W00000X | LPN.134843.MEDS-IV | OH | N | Nursing Service Providers | Licensed Practical Nurse | 251S00000X | N | Agencies | Community/Behavioral Health |
No ID Information.