Jeannine Mickulas

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

43 Arista Dr
Dix Hills, NY 11746-4920

Phone

(631) 683-4393

NPI assigned

Apr 25, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Welllife Network Inc

  • Case Management Agency
  • Elmont, NY
  • NPI 1508012816
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1245650407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 ARISTA DR",
            "city": "DIX HILLS",
            "state": "NY",
            "postal_code": "117464920",
            "telephone_number": "631-683-4393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 ARISTA DR",
            "city": "DIX HILLS",
            "state": "NY",
            "postal_code": "117464920",
            "telephone_number": "631-683-4393"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 Broadhollow Rd",
            "address_purpose": "LOCATION",
            "city": "Melville",
            "state": "NY",
            "postal_code": "117474822",
            "country_code": "US",
            "telephone_number": "631-385-7780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICKULAS",
        "first_name": "JEANNINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-25",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soel Melero Sr., R.PH.
• David Mendez
• Laurie Mercurio, RN
• Christine M Miceli, LMHC
• Lisa Ilene Mickle, SLP,CCC
• Vienna Migliaccio, LMSW
• Anita Miller, LMSW
• Arthur D Miller, DDS
• Lori Ellen Miller, O.T.R./L
• Teresa Marie Miller, PT, PHD, CFP

• All providers in Dix Hills, NY
• Behavior Technician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.