Miko E Douglas | Englewood, NJ • PECOS Search

Miko E Douglas

Social Worker

Behavioral Health & Social Service Providers

61 Grand Ave Ste 1, Englewood, NJ 07631-3599

(201) 541-8600 (914) 384-9852

PECOS Enrollment

Based on the most recent information from CMS, provider Miko E Douglas does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 26 days ago.

Profile Details

Provider ID
1114576287
Provider Type
Individual
Full Name
Douglas, Miko E
Title
Ms.

Gender
Female
Sole Proprietor
Yes
Enumeration Date
9/10/2019
Last Updated
9/10/2019

Contact Information

Practice Location

61 Grand Ave Ste 1, Englewood, NJ 07631-3599

(201) 541-8100

Mailing Location

PO Box 1701, Ossining, NY 10562-0075

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License Unlisted Issuer