Healthcare Provider Details

I. General information

NPI: 1639908049
Provider Name (Legal Business Name): KATHERINE JOHNSON MILLER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 BUCKEYSTOWN PIKE STE 170
FREDERICK MD
21704-8380
US

IV. Provider business mailing address

5301 BUCKEYSTOWN PIKE STE 170
FREDERICK MD
21704-8380
US

V. Phone/Fax

Practice location:
  • Phone: 240-575-9688
  • Fax:
Mailing address:
  • Phone: 240-575-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34235
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: