Healthcare Provider Details

I. General information

NPI: 1487679916
Provider Name (Legal Business Name): NANCY M MILLER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 DELMAR BLVD
SAINT LOUIS MO
63124-1990
US

IV. Provider business mailing address

8631 DELMAR BLVD
SAINT LOUIS MO
63124-1990
US

V. Phone/Fax

Practice location:
  • Phone: 314-787-5100
  • Fax: 314-754-2800
Mailing address:
  • Phone: 314-787-5100
  • Fax: 314-754-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number000279
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: