Healthcare Provider Details

I. General information

NPI: 1689970501
Provider Name (Legal Business Name): JOSEPH MILLER & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 SAN PEDRO DR NE 114
ALBUQUERQUE NM
87110-3368
US

IV. Provider business mailing address

2727 SAN PEDRO DR NE 114
ALBUQUERQUE NM
87110-3368
US

V. Phone/Fax

Practice location:
  • Phone: 505-239-1700
  • Fax:
Mailing address:
  • Phone: 505-239-1700
  • Fax:

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: MR. JOSEPH LEON MILLER JR.
Title or Position: PRESIDENT/ THERAPIST
Credential: LISW
Phone: 505-239-1700