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General NPI Number Information
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NPI Number | 1295236123
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Entity Type | Individual
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Provider Name | WENDELL DAVE MILLER LMSW
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Gender | Male
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 3 PETER CT
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City | SOUTH HUNTINGTON
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State | NY
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Zip | 11746-4501
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Country | US
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Telephone | 631-748-7730
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Fax |
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Provider Business Mailing Address
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Address Line | 66 PRIMROSE LN
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City | KINGS PARK
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State | NY
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Zip | 11754
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Country | US
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Telephone | 631-748-7730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8413
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 007714
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 127312
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License Number State | NY
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