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NPI Code Detail

MEDICARE: MR. JUSTIN MICHAEL MILLER LCSW

MEDICARE: MR. JUSTIN MICHAEL MILLER LCSW
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
11041C0700XClinical Social WorkerCW020036PA
2104100000XSocial WorkerBP00943159WV

General Provider Information

NPI Number : 1588974836
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JUSTIN MICHAEL MILLER LCSW
Provider Business Mailing Address
First Line : 11279 PERRY HWY STE 450
Second Line :
City : WEXFORD
State : PA
Zip : 15090-9303
Country : US
Telephone Number : 724-933-1100
Fax Number :
Provider Business Practice Location Address
First Line : 20630 ROUTE 19 UNIT 101
Second Line :
City : CRANBERRY TOWNSHIP
State : PA
Zip : 16066-6021
Country : US
Telephone Number : 724-779-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2010
Last Update Date : 11/20/2018

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