Healthcare Provider Details

I. General information

NPI: 1376479261
Provider Name (Legal Business Name): MARIN MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

600 MARKET ST
LEESBURG FL
34748-5143
US

IV. Provider business mailing address

PO BOX 895123
LEESBURG FL
34789-5123
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-2807
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: