MEDICARE: JENNIFER MILLER LICSW

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	113746	MA

General Provider Information

NPI Number	:	1194208314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MILLER LICSW

Provider Business Mailing Address
First Line	:	73 MOUNT WAYTE AVE
Second Line	:
City	:	FRAMINGHAM
State	:	MA
Zip	:	01702-5803
Country	:	US
Telephone Number	:	857-289-9082
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 NORTH PKWY STE 202
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01605-1349
Country	:	US
Telephone Number	:	857-289-9082
Fax Number	:

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

Provider Enumeration Date	:	09/13/2018
Last Update Date	:	08/30/2021

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