MEDICARE: MRS. KRISTIN JEAN MILLER M.S.W

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS 20890	CA

General Provider Information

NPI Number	:	1023104882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN JEAN MILLER M.S.W

Provider Business Mailing Address
First Line	:	2085 RUSTIN AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2498
Country	:	US
Telephone Number	:	951-715-5040
Fax Number	:	951-784-4976

Provider Business Practice Location Address
First Line	:	2085 RUSTIN AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2498
Country	:	US
Telephone Number	:	951-715-5040
Fax Number	:	951-784-4976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	04/03/2018

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