Healthcare Provider Details

I. General information

NPI: 1962847988
Provider Name (Legal Business Name): LUCRETIA A MILLER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4159 LOWELL BLVD
DENVER CO
80211-1658
US

IV. Provider business mailing address

4159 LOWELL BLVD
DENVER CO
80211-1658
US

V. Phone/Fax

Practice location:
  • Phone: 303-458-7220
  • Fax:
Mailing address:
  • Phone: 303-458-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0001175
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: