MEDICARE: GINA BRUNETTI MILLER MS, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	004076	MO
2	101YP2500X	Professional Counselor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	073138	OTHER	IL	HEALTH BENIFIT ALLIANCE
2	00132045	OTHER	IL	BLUE CROSS
3	491782	OTHER	IL	VALUE OPTIONS

General Provider Information

NPI Number	:	1083736235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA BRUNETTI MILLER MS, LCSW

Provider Business Mailing Address
First Line	:	3701 EAST LAKE CENTER DRIVE
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301
Country	:	US
Telephone Number	:	573-406-7643
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 E LAKE CTR
Second Line	:	STE 8
City	:	QUINCY
State	:	IL
Zip	:	62305-5842
Country	:	US
Telephone Number	:	573-406-7643
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	09/11/2025

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