Provider Demographics
NPI:1144716804
Name:MIKLAVE, ALEXANDER
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:MIKLAVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 COLLETTE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02746-2143
Mailing Address - Country:US
Mailing Address - Phone:203-505-4305
Mailing Address - Fax:
Practice Address - Street 1:180 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2733
Practice Address - Country:US
Practice Address - Phone:508-586-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)