Healthcare Provider Details

I. General information

NPI: 1437585445
Provider Name (Legal Business Name): STEVEN MILLER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 GRAND ST
NEW YORK NY
10002-4800
US

IV. Provider business mailing address

465 GRAND ST
NEW YORK NY
10002-4800
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-1970
  • Fax: 212-420-1910
Mailing address:
  • Phone: 212-420-1970
  • Fax: 212-420-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number092611
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number087736
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: