Healthcare Provider Details

I. General information

NPI: 1124082425
Provider Name (Legal Business Name): MARILYN M MILLER ISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18999 BISCAYNE BLVD SUITE 200
AVENTURA FL
33180-2814
US

IV. Provider business mailing address

735 NE 125TH ST
NORTH MIAMI FL
33161-5611
US

V. Phone/Fax

Practice location:
  • Phone: 305-933-9820
  • Fax: 305-933-9843
Mailing address:
  • Phone: 305-899-1587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW2611
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: