Healthcare Provider Details

I. General information

NPI: 1578375184
Provider Name (Legal Business Name): AMY LIU MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY LISA LIU

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 AIRPORT BLVD E
SANTA ROSA CA
95403-8049
US

IV. Provider business mailing address

132 AIRPORT BLVD E
SANTA ROSA CA
95403-8049
US

V. Phone/Fax

Practice location:
  • Phone: 707-232-4408
  • Fax:
Mailing address:
  • Phone: 707-232-4408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW137769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: