Healthcare Provider Details

I. General information

NPI: 1386080406
Provider Name (Legal Business Name): MICHELLE E. MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 MAIN ST 102
NEW PALTZ NY
12561-1623
US

IV. Provider business mailing address

PO BOX 95000
PHILADELPHIA PA
19195-4655
US

V. Phone/Fax

Practice location:
  • Phone: 845-255-2930
  • Fax:
Mailing address:
  • Phone: 800-444-6020
  • Fax: 845-256-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number088504
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0849201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: