Healthcare Provider Details

I. General information

NPI: 1740127133
Provider Name (Legal Business Name): LAURA ELLEN MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR STE 229C
BEVERLY MA
01915-6126
US

IV. Provider business mailing address

6 LUCERNE DR
ANDOVER MA
01810-1720
US

V. Phone/Fax

Practice location:
  • Phone: 978-969-2010
  • Fax: 978-969-1865
Mailing address:
  • Phone: 617-697-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW230524
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: