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General NPI Number Information
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NPI Number | 1366042111
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Entity Type | Individual
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Provider Name | JAYSON DANTE MILLER LMSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 180 LIVINGSTON ST STE 304
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City | BROOKLYN
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State | NY
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Zip | 11201-5861
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Country | US
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Telephone | 357-978-6365
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Fax |
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Provider Business Mailing Address
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Address Line | 356 MARION ST FL 3
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City | BROOKLYN
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State | NY
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Zip | 11233-2404
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Country | US
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Telephone | 925-819-1531
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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 | 105104
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License Number State | NY
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