Healthcare Provider Details

I. General information

NPI: 1235124702
Provider Name (Legal Business Name): PHILIP EDWARD MILLER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RUBIN DR
RUSHVILLE NY
14544-9681
US

IV. Provider business mailing address

1 S WASHINGTON ST STE 300
ROCHESTER NY
14614-1134
US

V. Phone/Fax

Practice location:
  • Phone: 585-554-4400
  • Fax:
Mailing address:
  • Phone: 585-325-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6026
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: