Healthcare Provider Details

I. General information

NPI: 1720697741
Provider Name (Legal Business Name): LORI A MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E END BLVD
WILKES BARRE PA
18711-0030
US

IV. Provider business mailing address

284 BODLE RD
WYOMING PA
18644-6011
US

V. Phone/Fax

Practice location:
  • Phone: 570-417-4110
  • Fax:
Mailing address:
  • Phone: 570-417-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018656
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: