Healthcare Provider Details

I. General information

NPI: 1437981099
Provider Name (Legal Business Name): REGGIE MILLER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 JACKSON AVE
SEAFORD NY
11783-2606
US

IV. Provider business mailing address

52 ALBERMARLE AVE
HUNTINGTON STATION NY
11746-2025
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-8888
  • Fax:
Mailing address:
  • Phone: 347-932-3722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number121261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: