MEDICARE: MR. JAMES RICHARD MILLER MSW

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	CW013547	PA
2	104100000X	Social Worker	CW013547	PA

General Provider Information

NPI Number	:	1629051545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES RICHARD MILLER MSW

Provider Business Mailing Address
First Line	:	USA MEDDAC ATTN: CREDENTIALS
Second Line	:	11050 MT BELVEDERE BLVD
City	:	FORT DRUM
State	:	NY
Zip	:	13603-5004
Country	:	US
Telephone Number	:	315-772-4025
Fax Number	:	315-774-4931

Provider Business Practice Location Address
First Line	:	USA MEDDAC ATTN: CREDENTIALS
Second Line	:	11050 MT BELVEDERE BLVD
City	:	FORT DRUM
State	:	NY
Zip	:	13603-5004
Country	:	US
Telephone Number	:	315-772-4025
Fax Number	:	315-774-4931

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	03/08/2022

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