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General NPI Number Information
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NPI Number | 1326473430
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Entity Type | Individual
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Provider Name | MS. KISHA LASHONE MILLER
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Gender | Female
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 1149 47TH AVE
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-5418
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Country | US
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Telephone | 646-306-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 11105 212TH ST
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-1811
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Country | US
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Telephone | 917-449-2674
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 72088854
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License Number State | NY
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