Healthcare Provider Details

I. General information

NPI: 1245422716
Provider Name (Legal Business Name): JOSEPH LEON MILLER JR. LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8338 COMANCHE RD NE SUITE B
ALBUQUERQUE NM
87110-2304
US

IV. Provider business mailing address

8338 COMANCHE RD NE SUITE B
ALBUQUERQUE NM
87110-2304
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-3665
  • Fax: 505-323-1038
Mailing address:
  • Phone: 505-323-3665
  • Fax: 505-323-1038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-05016
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: