Healthcare Provider Details

I. General information

NPI: 1750768602
Provider Name (Legal Business Name): NICOLE B MILLER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 W 3RD ST APT 2239
SOUTH ORANGE NJ
07079-1790
US

IV. Provider business mailing address

28 W 3RD ST APT 2239
SOUTH ORANGE NJ
07079-1790
US

V. Phone/Fax

Practice location:
  • Phone: 847-207-9590
  • Fax:
Mailing address:
  • Phone: 847-207-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089469
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06207900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: