Provider Demographics
NPI:1144063462
Name:OAKES, MIKHAIL (LSW)
Entity type:Individual
Prefix:MRS
First Name:MIKHAIL
Middle Name:
Last Name:OAKES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MRS
Other - First Name:MISHA
Other - Middle Name:
Other - Last Name:OAKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:532 OLD MARLON PIKE
Mailing Address - Street 2:P.O. BOX 128
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-832-5655
Mailing Address - Fax:
Practice Address - Street 1:1221 N CHURCH ST STE 101
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1245
Practice Address - Country:US
Practice Address - Phone:609-505-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06920100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker