Provider Demographics
NPI:1548522865
Name:MYCEK, KARA A (LCAT, BC-DMT)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:A
Last Name:MYCEK
Suffix:
Gender:F
Credentials:LCAT, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 OCEAN AVE OFC
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6715
Mailing Address - Country:US
Mailing Address - Phone:914-338-8449
Mailing Address - Fax:
Practice Address - Street 1:941 OCEAN AVE OFC
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6715
Practice Address - Country:US
Practice Address - Phone:914-338-8449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001732-1225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist