Healthcare Provider Details

I. General information

NPI: 1396905873
Provider Name (Legal Business Name): WENDY C MILLER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WALNUT ST
MIDDLETOWN MD
21769-8019
US

IV. Provider business mailing address

16 WALNUT ST
MIDDLETOWN MD
21769-8019
US

V. Phone/Fax

Practice location:
  • Phone: 301-371-3707
  • Fax: 301-371-3706
Mailing address:
  • Phone: 301-371-3707
  • Fax: 301-371-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12703
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: