Healthcare Provider Details

I. General information

NPI: 1649421835
Provider Name (Legal Business Name): CIPM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 03/03/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 MERRIMAC COURT
PRINCE FREDERICK MD
20678-0022
US

IV. Provider business mailing address

PO BOX 22
PRINCE FREDERICK MD
20678-0022
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-6520
  • Fax: 410-535-6523
Mailing address:
  • Phone: 410-535-6520
  • Fax: 410-535-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VENERA R MILLER
Title or Position: OWNER
Credential: M.D.
Phone: 410-535-6520