Healthcare Provider Details

I. General information

NPI: 1649721663
Provider Name (Legal Business Name): SHARON G MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 CHERRYVALE CT
TOMS RIVER NJ
08755-0845
US

IV. Provider business mailing address

1916 CHERRYVALE CT
TOMS RIVER NJ
08755-0845
US

V. Phone/Fax

Practice location:
  • Phone: 518-330-5525
  • Fax: 518-323-0706
Mailing address:
  • Phone: 518-330-5525
  • Fax: 518-323-0706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number098685
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06125100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089116
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: