Healthcare Provider Details

I. General information

NPI: 1104758879
Provider Name (Legal Business Name): ANDREA MILLER MSW, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 STANLEY AVE
CINCINNATI OH
45226-1718
US

IV. Provider business mailing address

417 STANLEY AVE
CINCINNATI OH
45226-1718
US

V. Phone/Fax

Practice location:
  • Phone: 765-426-9653
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: