| Doctor Name: | DR. STEPHEN MIKSIC |
| NPI Number: | 1184765125 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PS004073L |
| Business Practice Address: | 7 Embassy Cir East Norriton, PA - 194034011 |
| Business Phone Number: | 6105849721 |
| Business Fax Number: | 6105849721 |
| Mailing Address: | 7 Embassy Cir, EAST NORRITON |
| State: | PA |
| Postal Code: | 194034011 |
| Phone Number: | 6105849721 |
| Fax Number: | 6105849721 |
| NPI Enumeration Date: | 02/11/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TF0200X |
| License Number: | PS004073L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Forensic |
| Taxonomy Definition: | |