Healthcare Provider Details

I. General information

NPI: 1417366170
Provider Name (Legal Business Name): KRISTEN MARIE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HIGHLANDS BLVD STE 101
ARCHBALD PA
18403-1519
US

IV. Provider business mailing address

1 HIGHLANDS BLVD STE 101
ARCHBALD PA
18403-1519
US

V. Phone/Fax

Practice location:
  • Phone: 570-536-0135
  • Fax:
Mailing address:
  • Phone: 570-536-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCW018731
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: